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: Moffett, Carol
- 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.
Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of this project was to evaluate the impact of IP with attention to identifying and addressing social needs of patients with T2DM. Participants at least 18 years of age with an A1C >6.5% were identified; Spanish speaking patients were included in this project. The intervention included administration of Health Leads questionnaire to assess social needs. Monthly in person or phone meetings were conducted during a 3-month period.
The patient had the option to meet with the doctor of nursing practice (DNP) student as well as other members of the team including the clinical pharmacist and social work intern. Baseline A1C levels were extracted from chart at 1st monthly meeting. Post A1C levels were drawn at the 3 month follow up with their primary care provider. Study outcomes include the difference in A1C goal attainment, mean A1C and patient satisfaction. Pre A1C levels in participants ranged from 7.1% to 9.8% with a mean of 8.3%. Post A1C levels ranged from 6.9% to 8.6% with a mean of 7.7%. Two cases were excluded as they did not respond to the intervention. A paired-samples t test was calculated to compare the mean pre A1C level to the post A1C level. The mean pre A1C level was 8.24 (sd .879), and the post A1C level was 7.69 (sd .631). A significant decrease from pre to post A1C levels was found (t (6) = 2.82, p<.05).
The prevalence of Type 2 Diabetes is on the rise, as are the costs. This nation’s healthcare system must promote interprofessional collaboration and do a better job of addressing SDOH to more effectively engage patients in the management of their disease.
The chronic nature of substance use disorder requires continuity of care after residential treatment. Only a small proportion of patients, however, adhere to aftercare follow-up plans and the relapse rates remain between 40- 80% within a year post-discharge. Synthesis of evidence showed that facilitated referral (FR) significantly increased follow- up adherence and resulted to positive outcomes. The study aimed to examine the effectiveness of FR in improving access, follow-up adherence and engagement to aftercare services, and relapse rate after a month post- discharge.
After the Institutional Review Board approval, 30 participants were recruited in two residential treatment facilities. Questionnaires, the Assessment of Warning Signs of Relapse and Health leads surveys were utilized to collect data. Data were analyzed using descriptive statistics, McNemar, and Wilcoxon signed rank tests. Results showed that FR significantly increased access to many community aftercare services (p<.05). A significant reduction in relapse risk post-intervention was also noted (Z= -3.180, p= .001). Additionally, most participants discharged with scheduled appointments followed-up and had continued engagement with aftercare services. Eight participants maintained sobriety and 18 were lost to follow-up a month post-discharge, while four relapsed in the facility.
Overall, FR increased access to needed aftercare services and significantly decreased the relapse percentage risk post-discharge. FR is a promising intervention that can be implemented for practice. Future research is recommended to further examine the correlation with follow-up adherence and continuous engagement to aftercare services, and relapse rate at 30 days after discharge.
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.