Doctor of Nursing Practice (DNP) Final Projects

Background: 
Approximately 1 in 5 U.S. school-aged children are obese. There are many known health complications associated with obesity including premature death. Family-based obesity interventions that promote healthy lifestyle habits are effective at enabling children to make changes needed to avoid long-term health complications associated with obesity. The purpose of this evidence-based practice intervention was to evaluate the effectiveness of a family-based obesity intervention on familial lifestyle behaviors related to nutrition, physical activity, and screen time.

Methods:
Two overweight-obese children (according to CDC criteria) ages 8-12 years old visiting a pediatric primary care clinic in a suburban neighborhood located in the southwest region were recruited to participate in this evidence-based practice intervention based on inclusion and exclusion criteria. Familial lifestyle behaviors were assessed using the Family Health Behavior Scale (FHBS) prior to receiving an educational intervention addressing nutritional, physical activity, and screen time recommendations and again after following these recommendation for 6-weeks. Additionally, scheduled follow-up phone calls were made every 3 or 6-weeks addressing any parental questions that surfaced. Data was insufficient for statistical analysis, however, anecdotal recommendations for future implementation of this intervention resulted.

Results:
Of the two patients who participated, pre- and post-intervention data was only attainable from one patient. That patient did have improved scores within each of the 4 FHBS subscales (parent behaviors, physical activity, mealtime routines, and child behaviors). Overall, 11 of the 27 behaviors assessed improved, 12 behaviors resulted in no change, and 4 behaviors worsened. Recommendations related to a more successful implementation of this intervention in the future include improved provider participation (buy-in), utilization of broader inclusion criteria, consideration of the implementation time-frame, and application of the Health Belief Model for addressing existing barriers for each patient prior to implementing the intervention.

Conclusions:
In order to determine the effectiveness of this intervention a larger sample size and completed post-intervention data are needed. The small sample size and lack of post-intervention data inhibits proper data analyzation and significance from being determined.

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.

Homeless individuals encounter barriers such as lack of health insurance, increased cost of care and unavailability of resources. They have increased risk of comorbid physical disease and poor mental health. Depression is a prevalent mental health disorder in the US linked to increased risk of mortality. Literature suggests depression screening can identify high-risk individuals with using the patient health questionnaire (PHQ-9).

The objective of this project is to determine if screening identifies depression in the homeless and how it impacts healthcare access. Setting is a local organization in Phoenix offering shelter to homeless individuals. An evidence-based project was implemented over two months in 2019 using convenience sampling. Intervention included depression screening using the PHQ-9, referring to primary care and tracking appointment times. IRB approval obtained from Arizona State University, privacy discussed, and consent obtained prior to data collection. Participants were assigned a random number to protect privacy.

A chart audit tool was used to obtain sociodemographics and insurance status. Descriptive statistics used and analyzed using Intellectus. Sample size was (n = 18), age (M = 35) most were White-non-Hispanic, 44% had a high school diploma and 78% were insured. Mean score was 7.72, three were previously diagnosed and not referred. Three were referred with a turnaround appointment time of one, two and seven days respectively. No significant correlation found between age and depression severity. A significant correlation found between previous diagnosis and depression severity. Attention to PHQ-9 varied among providers and not always addressed. Future projects should focus on improving collaboration between this facility and providers, increasing screening and ensuring adequate follow up and treatment.

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.

Purpose: The purpose of the project was to improve physical activity (PA), eating habits (EH) and self-efficacy (SE) by implementing short lifestyle modification education in a rural primary care setting.

Background: Although prediabetes awareness has slightly improved, the nationwide unawareness remains high. General knowledge about the disease and its risk factors and prevention are significant variables to adopt health-promoting behaviors. Lifestyle change intervention has been shown to be effective with the risk reduction behaviors in prediabetic population. However, it can be a daunting task to translate during short office visits.

Methods: Sixteen participants with risk for prediabetes or diagnosed prediabetes enrolled into a 5-minute education session in a rural health clinic. They received follow-up phone calls weekly for 4 weeks. Demographics, PA, EH and SE levels were measured before the education session. During the fourth week, PA, EH and SE were measured again. Frequency, descriptive analysis, and paired t-test were used for data analysis.

Outcomes: The mean age of participants was 56.6  13.0 years. Approximately 81% were female, and 62.5% identified as Caucasian. Over 80% reported married, and 56.3% described their health condition as good. The three quarters (75%) noted they have heard of the term prediabetes. The intervention had a significant effect on PA, EH and SE from the baseline to post intervention, p = .005, p = .008, and p = .003, respectively.

Conclusion: This DNP project illustrated that one time brief lifestyle change education could positively impact PA, EH and SE in people with high risk for prediabetes in a primary care clinic.