Doctor of Nursing Practice (DNP) Final Projects

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.

Background: Cyberbullying and cyber-victimization are rising problems and are associated with increased risk for mental health problems in children. Methods for addressing cyberbullying are limited, however, interventions focused on promoting appropriate parental mediation strategies are a promising solution supported by evidence and by guided by the Theory of Parenting Styles.

Objective: To provide an educational session to parents of middle school students that promotes effective methods of preventing and addressing cyberbullying incidents. Design: The educational sessions were provided to eight parents middle school student. Surveys to assess parent perception of and planned response to cyberbullying incidents and Parent Adolescent Communication Scale (PACS) scores were collected pre-presentation, post-presentation, and at one-month follow up.

Results: Data analysis of pre- and post-presentation PACS using a Wilcoxon test found no significant difference (Z = -.405, p >.05). There was not enough response to the 1-month follow-up to perform a data analysis on follow-up data.

Conclusions: Due to low attendance and participation in the follow-up survey the results of this project are limited. However, parents did appear to benefit from communicating concerns about cyberbullying with school officials. Future studies should examine if a school-wide anti-cyberbullying program that actively involves parents effects parental response to cyberbullying.

Type II Diabetes Mellitus has detrimental effects on the human body. A1C levels reflect the attachment of glucose to hemoglobin-the protein in red blood cells that carries oxygen. Elevated A1C levels are an indicator of how controlled diabetes is. Uncontrolled diabetes not only affects glucose levels, but has detrimental repercussions in other organs of the body, causing peripheral vascular disease, risk of developing dementia, periodontal or gum disease, skin infections, neuropathy in lower and upper extremities, renal damage, erectile dysfunction, decreased blood flow, and cardiac conditions among others.

A diet low in calories positively affects glucose levels in the body. Type II Diabetes can be easily controlled when lifestyle modifications are included in the plan of care. Among those modifications, diet is an effective intervention for the management of this condition.
Establishing a diet among the patients that have an elevated A1C is the plan of care and ultimate goal for this project. The Mediterranean diet has demonstrated decreased blood glucose levels, improved weight control and enhanced quality of life.

Background and Purpose:
Depression in older adults is a significant problem that often goes undetected and untreated in primary care. The U.S. Preventive Services Task Force recommends screening adults for depression in primary care to increase detection, so it can be adequately managed. Despite this recommendation, screening rates in primary care are low. The purpose of this project was to implement a screening intervention and examine the effect of screening on the treatment of depression in older adults.

Methods:
The screening intervention was implemented as an evidence-based project in a small primary care practice. Consenting adults ≥ 65 years of age were screened with the Patient Health Questionnaire-9 (PHQ-9). Research indicates the PHQ-9 is valid and reliable for older adults. A post-screening chart audit was conducted to collect data and analyze the outcome of screening related to treatment.

Conclusions:
A total of 38 participants were screened. Five (13.2%) participants had a positive screening, two received treatment during the follow up period. The number of participants who were treated after a positive screening was significant (p= .040).

Implications for Practice:
Screening can increase detection and treatment of depression and reduce the associated illness burden in the older adult population.