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.

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College of Nursing and Health Innovation
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Background: Type II diabetes mellitus (T2DM) is a growing issue globally. Social determinants of health (SDH) play a crucial role on patients’ outcomes and complications from the disease. Hispanics are twice as likely to suffer from T2DM when compared to non-Hispanic whites, and they often rely on federally qualified community

Background: Type II diabetes mellitus (T2DM) is a growing issue globally. Social determinants of health (SDH) play a crucial role on patients’ outcomes and complications from the disease. Hispanics are twice as likely to suffer from T2DM when compared to non-Hispanic whites, and they often rely on federally qualified community health centers (FQCHC) for their medical needs. These centers are then faced with high volume of patients with high acuity, which leads to limited time and resources to provide diabetic education. Methods: The Purnell model of cultural competence will be used as a framework to provide unbiased, culturally tailored (CT) education to improve patients’ outcomes. The advancing research and clinical practice through close collaboration (ARCC) model will be used as it focuses on evidence-based practice (EPB) implementation that is sustainable across the system. Purpose: The purpose of this EBP project is to promote culturally tailored (CT) DSME at a low-income FQCHC in greater Phoenix to improve diabetes outcomes and decrease complications from the disease. Consequently, decreasing the costly effects of diabetes complications to patients, FQCHC, and the state of Arizona. Conclusion: Evidence suggest that diabetes self-care management education (DSME) is successful, independent of the format of delivery, in improving diabetes outcomes and patients’ self-care. However, it is underutilized in the United States even though it is a covered Medicare service.
Created2021-04-28
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Description
A federally qualified health center in the southwest United States serves low-income, uninsured communities. By provider reports, unprescribed antibiotic use is common in this clinic’s population, promoting development of antibiotic resistant bacteria. Antibiotics are widely available in Mexico and may be sold illegally in the United States without a prescription.

A federally qualified health center in the southwest United States serves low-income, uninsured communities. By provider reports, unprescribed antibiotic use is common in this clinic’s population, promoting development of antibiotic resistant bacteria. Antibiotics are widely available in Mexico and may be sold illegally in the United States without a prescription. This project’s purpose is to identify social risks and opportunities for antibiotic education. A telephone survey was administered to patients at least 18 years of age. The 32-item survey included a demographic questionnaire created for this project, the PRAPARE social determinants of health questionnaire, and the Eurobarometer antimicrobial resistance questionnaire. Any social risks identified were forwarded to clinic staff for referral. The survey was completed in English or Spanish, per the participant’s preference. A total of 20 surveys were completed. Low education level and unemployment were the most common social risks identified. Spanish language, housing and food insecurity, and difficulty meeting basic needs were associated with overall higher social risks. An antibiotic knowledge gap was identified, and self-medication with antibiotics was confirmed as a behavior within the population. Although no determinants for antibiotic misuse were identified, all participants indicated preference for provider-based education. This FQHC has an opportunity to develop a provider-based educational intervention. The length of the survey and the telephone format, required due to COVID-19 restrictions, were significant limitations, impacting recruitment. Further research is needed to determine the most effective way of delivering education. The clinic is continuing to administer the PRAPARE survey, expanding data on social risks.
Created2021-04-28
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Description
Purpose: Hispanics diagnosed with type 2 diabetes mellitus (DM) have poorer health outcomes than non-Hispanic whites. Approximately one- half of all Hispanic DM patients utilize community health clinics for their DM needs. Evidence suggests that using a culturally-tailored approach to DM education can uniquely improve health outcomes in this population.

Purpose: Hispanics diagnosed with type 2 diabetes mellitus (DM) have poorer health outcomes than non-Hispanic whites. Approximately one- half of all Hispanic DM patients utilize community health clinics for their DM needs. Evidence suggests that using a culturally-tailored approach to DM education can uniquely improve health outcomes in this population. The purpose of this evidence-based practice (EBP) project was to improve glycemic control in a medically underserved Hispanic community through a culturally-tailored DM education program.

Methods: This quasi-experimental pre/post design project was guided by the ACE Star Model and Leininger’s Theory of Cultural Care. The affiliated University’s IRB approved this project. The Diabetes Empowerment Education Program (DEEP) was implemented in a free, community clinic in a medically underserved area. Spanish speaking patients (n = 15) with A1C levels
> 8mg/dl were recruited to participate in a 6-week group educational program facilitated by community health workers. Outcomes included A1C levels, weight, and two surveys from the Michigan Diabetes Research Center - DM knowledge test and the DM empowerment scale.

Results: Paired sample t-tests were used to analyze the outcomes. The participants had an average pre-A1C of 8.82 mg/dl with post-A1C of 8.01 mg/dl (p = .028). Pre-knowledge test scores averaged 9.40 with post-test average of 12.07 (p < .001). Empowerment scores increased from 4.09 to 4.63 (p = .001). The reduction between the average pre-and post-weight measures were not statistically significant (p = .681).

Discussion: The implementation of a culturally-tailored DM educational program in a medically underserved community had a significant impact on reducing A1C levels, improving DM knowledge, and enhancing empowerment levels. Although the sample size was small and limited to one clinic, applying these programs can have a measurable clinical impact in the treatment of Hispanic DM patients. Future research can further exam how to duplicate this project on a larger scale and over a sustained period.
ContributorsBrown, Fionnuala S. (Author) / Thrall, Charlotte (Thesis advisor)
Created2018-04-23
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Description

Current obesity statistics exceed national goals with Hispanics disproportionately affected. Evidence suggests a family centered methodology focusing on culture can positively improve weight loss, client satisfaction and participation. This project will evaluate use of culturally tailored resources for primary care providers to educate Hispanics on weight loss. Eight providers in

Current obesity statistics exceed national goals with Hispanics disproportionately affected. Evidence suggests a family centered methodology focusing on culture can positively improve weight loss, client satisfaction and participation. This project will evaluate use of culturally tailored resources for primary care providers to educate Hispanics on weight loss. Eight providers in a small practice in the Southwestern US were recruited to complete a pre- and postEBPAS tool after an educational session. A BMI form tracked provider use of the fotonovela intervention against preferred methods.

Feedback on time spent educating and overall perception were collected. Four providers completed the pre-EBPAS, three completed the post-, one participated in the intervention, and six contributed project feedback. Descriptive statistics revealed an aggregate provider decrease of five-points post-educational session for attitude toward adopting EBP. The BMI documentation form demonstrated a 53% (n = 8) use of the fotonovela. However, there were five undocumented fotonovelas taken/given out postintervention. Key themes noted by providers included poor timing of the project, satisfaction with workflow and resources, and overall discontent for the fotonovela. Future implications include re-evaluating the project in a practice not undergoing significant changes with specific focus on timing of the intervention.

ContributorsMunson, Megan A. (Author) / Bay, Sarah (Thesis advisor)
Created2018-04-30