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.
Filtering by
- Creators: Guthrey, Ann
- Creators: LaBronte, Kimberly
Background: Neonatal hypoglycemia (NH) is a common problem in the newborn period that resolves by 24-48 hours of life. Infants with known NH risk factors take longer to achieve blood glucose homeostasis. The leading cause of neonatal intensive care unit (NICU) admissions in otherwise healthy term and late preterm infants is NH.
Purpose: To determine the efficacy of dextrose gel in addition to oral feedings in NH treatment as compared to the previous practice of oral feedings alone. Lewin's change theory was used in staff education and project implementation.
Methods/Search Strategy: A keyword search of CINHAL, Cochrane, and PubMed with restrictions to English and publications within 5 years revealed supportive data for the practice change. IRB approval obtained prior to the practice change. Nurses screened all newborns for NH risk factors at birth at a tertiary hospital in the southwestern U.S. Infants with specific criteria received oral dextrose gel with timed follow-up blood glucose levels following an NH algorithm.
Findings/Results: Two groups of infants with similar gestational ages, birth weights, and risk factors for NH were compared pre and post-implementation of the EBP change. Infants in the first group (n=27) were all born prior to the start of the project and therefore were all treated with IV dextrose in the NICU after failing to maintain blood glucose levels within normal ranges with oral feedings alone. The second group of infants (n=27) was treated based on an updated NH algorithm after implementation of the use of oral dextrose gel. Of those 27 infants, 24 received oral dextrose gel for NH treatment. Of respiratory distress in addition to NH so these infants were excluded in the statistical analysis of NICU admissions. Therefore the post-implementation group only had 2 admission for primary diagnosis of NH. When comparing admission rates for hypoglycemia between the two groups, the first group had a 100% admission rate while the second group (those who received oral dextrose gel) only had a 9% admission rate for neonatal hypoglycemia (p<0.001). Upon further investigation it was found that these 2 infants admitted to the NICU with the diagnosis of NH had multiple risk factors present, including being infants of diabetic mothers which means they likely experienced refractory hypoglycemia after treatment with oral dextrose gel secondary to hyperinsulinism. Hyperinsulinism can lead to persistent and profound hypoglycemia in the newborn that is more difficult to treat, which is of clinical significance.
Implications for Practice: Early identification with timely follow-up blood glucose levels following intervention may be critical to successful treatment without requiring NICU admission. Nursing education and parental support are also paramount to success. If the change in NICU admissions for NH is statistically significant with a larger sample size, results may be shared with other facilities that traditionally transfer these infants for a higher level of care.
Implications for Research: Studies with larger sample size may generate more generalizable data with fewer outliers. Studies comparing neurodevelopmental outcomes among infants who received different NH treatments are necessary to determine long-term safety.
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.
Design: The primary hypothesis was that active participation as defined by contact with a sponsor of an hour or more per week, as measured by the impact on affective characteristics correlated with increased levels of sobriety, when measured by the AWARE questionnaire (Advance Warning of Relapse) within 7 days of entry and prior to discharge (within 30 days). Setting: The project took place in a residential treatment facility in Phoenix, Arizona.
Participants: There were 12 clients from a men’s house and 12 clients from a woman’s house, all of which were going through recovery. Intervention: The educational session explained what a sponsor is and the importance of finding one early as a key role in relapse prevention.
Measurements: Pre and post-test results were compared to see if there was an impact on the predictability of relapse and sponsorship. The paired t-test was performed to compare the two means of AWARE scores. A lower score on the AWARE questionnaire indicates a person is more likely to succeed in sobriety.
Findings: Based on 24 samples collected, the mean scores within the first seven days were 91.17 with a standard deviation of 18.59 and the mean score prior to discharge were 72.78 with a standard deviation (SD) of 20.02. The mean difference between the two scores was 18.39 (SD=2.84). There was a significant effect of the relapse prevention program which included sponsorship, t (22) = 4.79, p < 0.001.
Conclusion: Implications for practice include increased time with sponsors to reduce rates of relapse. Future concerns include good fit matching which may reduce rates of relapse even further.
Introduction: More than 1.2 million children in military families face long separations from a parent due to deployment or extended assignment, which can lead to significant family dysfunction as well as behavioral, emotional, and scholastic problems for the child. The purpose of From Caring 2 Coping is to identify and provide healthcare providers of military children tools to recognize and address maladaptive and externalizing behaviors of these children, while also assisting the nondeployed parent or caregiver to provide their children with the necessary support to reduce stress and increase their own coping skills.
Materials and Methods: After approval from Arizona State University IRB, children aged 4-11 years who are currently or forecasted to be separated from a military parent due to a deployment or extended assignment, were recruited from a military pediatric clinic along with their primary caregiver. An intervention was adapted from Bowen and Martin’s (2011) Resiliency Model of Role Performance for Service Members, Veterans, and their Families to identify and improve individual assets and family communication skills, find support through social connections, and prepare for potential stressors by constructing a Roadmap of Life. The Parental Stress Scale (PSS) and Pediatric Symptom Checklist (PSC-17) were completed before and after the 4-week intervention along with a final caregiver survey to evaluate the caregiver’s perceptions of From Caring 2 Coping.
Results: Four mothers and eight children completed the program for which Wilcoxon matched-pairs signed-rank test compared results from pre- and post PSC-17 surveys from the children showing significant improvement post-intervention (p = 0.017). The post PSC-17 results were compared to post PSS results with Spearman Correlation Coefficient, r = 0.949, that is statistically significant (p = 0.05). From Caring 2 Coping is rated as an effective program by parents in a postintervention survey that is easy to incorporate into daily activities. Parents ranked highest satisfaction through use of the Family Communication Plan and Family Timeline.
Conclusions: From Caring 2 Coping intervention tools improved family communication, use of individual assets and Roadmap of Life coping skills, thereby improving child and caregiver coping response as evidenced by improved PSC-17 and PSS scores. Basing the intervention on the Resiliency Model of Role Performance which has proven successful in the military population, improves the chances for success in this target population. However, the small sample size of four families requires further study with more families at all levels of the deployment cycle in order to refine the intervention.
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.