Doctor of Nursing Practice (DNP) Final Projects

Childhood traumatic experiences are a prevalent public health issue. Children exposed to trauma often exhibit behaviors that make educating them challenging. Preschool teachers at a southwestern United States preschool receive no training related to childhood trauma and resilience. The purpose of this project was to educate preschool teachers on trauma and resilience to improve attitude related to educating children with trauma.

Following Arizona State University Internal Review Board approval, preschool teachers were recruited from a non-profit metropolitan preschool. Project included two pre-training questionnaires (Adult Resilience Measure-Revised [ARM-R] and Attitudes Related to Trauma Informed Care scale [ARTIC]), one two-hour training via Zoom on childhood trauma and resilience, and post-training ARTIC questionnaire at two and six weeks.

Seven teachers (n=7) participated in pre-training questionnaires, and three of these teachers (n=3) participated in both post-training questionnaires. All participating teachers were female and Caucasian. Average age of participants was 49.43 years (SD=8.40, range 36-60), and experience average was 17.17 years (SD=10.15, range 3-30). AMR-R average score was 72.29 (SD=8.28, range 61-83). Pre-training ARTIC score average was 3.87 (SD=0.16). Post-training ARTIC scores at two weeks and six weeks post-training were 3.65 (SD=0.22) and 3.86 (SD=0.25).

Clinical significance included improved teacher awareness of childhood trauma and improved ability to interact with children exposed to trauma. Teachers exhibited high resilience scores. Additional research needed related to further address educating preschool teachers related to trauma informed care, related to building resilience in children, and related to the impact of teacher resilience on trauma informed care.

Keywords: teacher training, adverse childhood experiences, ACEs, childhood trauma, resilience

Purpose: The purpose of this project was to implement health promotion education for overweight and obese adults with endocrine disorders. The overarching goal was to change dietary intake and improve exercise to reduce the incidence, prevalence, and impact of comorbidities associated with obesity.

Background/Synthesis: Obesity is a significant epidemic facing the nation today with multiple impacts on the national healthcare system. There is often an association between obesity and endocrine disorders such as type 2 diabetes and prediabetes. Both obesity and diabetes cost the nation billions of dollars annually in healthcare costs. Evidence shows that lifestyle modifications related to nutrition and physical activity are effective in weight reduction and prevention of chronic disease, especially when given by a healthcare provider.

Methods: Fifteen adult patients at an endocrinology office in Arizona received individual counseling using the teach-back method focusing on health promotion behaviors through nutrition and exercise with a two-week follow-up phone call. Short-term outcomes measured in this project included changes in dietary intake and exercise behaviors through a pre- and post-test adapted from an obesity-screening tool developed by Greenwood et al. (2008).

Outcomes/Results: Participants were primarily Caucasian and Hispanic, married, female, average age of 50 years, average BMI of 34.5, and some college education. There was a statistically significant increase in health promoting behavior on posttest scores (M=66, SD=6.23, range=58-76) compared to pretest scores (M=61, SD=4.72, range=50-66), t(14)=-2.55, p=0.023.

Conclusions and Implications: Overall, patient health promotion behaviors increased with this educational intervention. Clinical implications include a potential decrease in patient comorbidities related to overweight and obesity. Implications for the greater healthcare system include decreased comorbidities, utilization of healthcare resources, and costs associated with overweight and obesity. Future recommendations would include determining weight and BMI changes over a longer period of time for even better outcome measures.

Keywords: obesity, obese, overweight, health promotion, health education, diet, exercise, nutrition