Doctor of Nursing Practice (DNP) Final Projects

SolarSPELL is a digital learning library created at Arizona State University for
educational environments in the Pacific and East Africa. The library is curated to deliver information to resource-challenged communities around the world, providing culturally relevant materials in a solar-powered data repository. A new SolarSPELL health library was deployed in a border-adjacent community in Sonora, Mexico to enhance health education resources. The Sonoran SolarSPELL (SSS) library is a community-driven model established through Doctor of Nursing Practice (DNP) leadership and reflects the innovative focus of SolarSPELL.

The purpose of this report is to contextualize the Sonoran SolarSPELL experience, identify opportunities for process improvement and innovative leadership, and identify an evidence-based framework to guide implementation in new communities. Implementation framework utilization is especially important in the integration of technology into healthcare settings, where barriers can be novel and complex. Key focal points included the development of strong partnerships with the community members, collaborative design, and leadership roles of DNPs in project development and implementation. This study provides a paradigm for both DNP leadership and the application of innovative healthcare technologies in under-served communities throughout the world.

Obesity is a significant national public health crisis, affecting one-third of American adults. It is a complex and multifactorial disease that increases the risk of multiple chronic medical conditions including coronary heart disease, diabetes, and even leading to potential premature mortality. Moreover, increased health care utilization and escalating medical costs associated with obesity treatment are overwhelming an already burdened health care system. Obesity is nondiscriminatory, affecting individuals from various demographic and socioeconomic backgrounds, even extending to our unique population of active duty military service members and veterans.

Despite mandatory physical fitness and body composition requirements, active duty service members continue to experience an increasing prevalence of obesity. The obesity epidemic has considerable implications for military readiness, accession, and retention. Limited studies have examined weight-loss interventions including self-paced and provider-led interventions among active duty military service members with varying degrees of success. The purpose of this evidence based doctoral project was to examine the effectiveness of a twelve-week group lifestyle intervention involving education regarding healthy diet, physical activity and behavior change recommendations on weight and body mass index (BMI). The study demonstrated no significant differences in initial and post intervention weight and BMI.

Nurses working in China do not have access to hospital data, access to professional organizations, or to the internet for reviewing evidence-based practice (EBP). Chinese healthcare organizational leaders are seeking international support to provide nurse leaders with necessary skills to lead China based organizations in safe, quality, healthcare delivery.

With the opening of a new hospital in Yinchuan, China, it is imperative to ensure that a climate of collaboration, teamwork, and clear communication methods exist between nurses, doctors, and other interprofessional staff members. Evidence indicates that use of simulation with standardized communication tools and processes (use of Situation-Background- Assessment-Recommendation [SBAR], TeamSTEPPS, and checklists) can facilitate interprofessional collaboration and teamwork and improve communication among interprofessional staff. Designing effective simulation scenarios with sensitivity to Chinese culture, with an interprofessional staff will enhance quality and patient safety in Chinese hospitals.

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.

There is an increasing number of cancer patients outliving their diagnosis and treatment and requiring more support as they transition to cancer survivors. To bridge this gap, survivorship care plans should be provided to all cancer survivors to provide post treatment plans of care, recommendations, and resources (Commission on Cancer, 2016). A quality improvement project was implemented in the urology practice of a National Cancer Institute-designated, academic hospital in Phoenix, Arizona to provide survivorship care plans to prostate cancer patients with surgical intervention as their cancer treatment.

Through interprofessional collaboration, the process change was designed and implemented with the residents and Physician Assistants of the urology practice. There was a 93% adherence rate in delivering the survivorship care plans during the project. The “Confidence in Survivorship Information” questionnaire was used to measure the patients’ confidence in survivorship information prior to and after receiving a survivorship care plan. A paired t-test showed statistical significance in improvement in confidence in the knowledge of long-term physical effects of cancer treatment, strategies for preventing and treating long-term physical effects, and resources available for family members who may be at risk. The project will continue in order to meet requirements for cancer programs established by the Commission on Cancer (Commission on Cancer, 2016).

In today’s healthcare environment, there is ample evidence to support early identification of disease and implementation of effective treatment to improve patient outcomes. The objectives of this clinical intervention were twofold; the implementation of an innovative change within an organization, allowing for systematic screening through incorporation of the Mood Disorder Questionnaire (MDQ), and evaluation of mental health provider’s willingness to incorporate practice change.

A pre- and post-quasi-experimental design evaluated the attitude of providers regarding practice change using the Evidence-Based Practice Attitude Scale and the utilization of the MDQ following educational intervention. Parametric testing was used to explore the relationship between education specific to practice change and the provider's attitude through the use of the paired t test. The Chi-square test evaluated the use of the MDQ by clinic healthcare providers in relation to an innovative practice change.

Results of this study illustrate enhanced provider willingness to adopt innovation and increased MDQ use following the intervention. Ensuring provider access to screening tools and education during the process of practice change provides a strategy for early intervention enhanced willingness to support practice evolution.