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- Member of: Doctor of Nursing Practice (DNP) Final Projects
- Member of: ASU Electronic Theses and Dissertations
- Status: Published
Description
Children are five times more likely to be overweight at the age of 12 years if they are overweight during the preschool period, and 60% of overweight preschoolers are overweight at the age of 12 years (Matusik & Malecka-Tendera, 2011). Primary care interventions are urgently needed to improve healthy lifestyle behaviors in families. Parental influence plays an important factor in the development of healthy behaviors in children. Cognitive behavioral interventions have demonstrated preliminary success in promoting healthy lifestyle behaviors in both adults and children. Mobile technology used to supplement interventions aimed at behavior change offers an outlet to bridge gaps in health disparities and generate innovative evidence. Therefore, the purpose of this research was to establish the feasibility, acceptability, and preliminary effects of a cognitive-behavioral intervention (TEXT2COPE) synergized with mobile technology on the healthy lifestyle behaviors of parents of overweight and obese preschoolers. Primary aims of the proposed pilot study were to (a) examine the feasibility and acceptability of the TEXT2COPE program among parents of overweight or obese preschoolers with mobile phones; (b) evaluate the preliminary effects of the TEXT2COPE program on healthy lifestyle behaviors in families with overweight or obese preschoolers; and (c) evaluate the relationship among the study variables (i.e., cognitive beliefs, perceived difficulty, and healthy lifestyle behaviors). Findings indicate that this program is feasible and acceptable in this population. The intervention improved healthy lifestyle beliefs and behaviors in parents. Further supported are the interconnected relationships between parental beliefs, thoughts, and behaviors.
ContributorsMilitello, Lisa K (Author) / Melnyk, Bernadette M (Thesis advisor) / Small, Leigh (Committee member) / Hekler, Eric (Committee member) / Jacobson, Diana (Committee member) / Arizona State University (Publisher)
Created2014
Description
ABSTRACT Approximately 3.5% of adolescents in the United States have chronic daily headache (CDH). Chronic daily headaches in adolescents are often refractory to the adult pharmacological interventions. And as a result, adolescents typically experience increased levels of stress, which exacerbates their headaches. Chronic daily headaches negatively impact both the adolescent and their family. Adolescents with CDHs frequently exemplify comorbid psychiatric symptoms such as anxiety, depression, and increased risk for suicide. Risk factors for CDH in adolescents have been well studied; however, few studies have focused on psychologically based interventions to enhance effective coping, positive mental health, and pain relief in this group of teens. Given the paucity of psychologically focused interventions in this group, further research is necessary to test and develop the effectiveness of cognitive behavioral skills building (CBSB) interventions. This pilot study focused on the use of a CBSB intervention that emphasized problem solving, cue recognition, effective communication, behavior modeling, cognitive reappraisal, stress management, effective coping, and positive thinking. A randomized controlled trial pilot study was conducted. The intervention group received a seven-week intervention focused on CBSB techniques and headache education, while the comparison headache education group received a seven-week program focused on basic headache hygiene measures (e.g., adequate sleep, adequate hydration, dietary triggers, environmental triggers). The total sample included 32 adolescents inclusive of the ages 13 and 17 years. Paired t-tests resulted in significant preliminary positive effects for COPE-HEP on anxiety, depression, beliefs, headache disability, headache frequency, and headache duration. Comparison group education resulted in significant preliminary positive effects on anxiety, depression, headache disability, headache frequency, headache pain level, headache duration, and medication frequency. There were no significant changes over time in means of parent perception of pain interference for both groups. Independent t-tests revealed that COPE-HEP teens had significantly less anxiety and headache duration at post-intervention. The acceptability of the COPE-HEP intervention with adolescents with CDHs in a specialty care setting is supported by this study, while the feasibility of conducting this study in a specialty care setting is partially supported. These findings support a need to refine the intervention and test both its short and long-term effects in a full-scale randomized controlled trial with adolescents who have CDHs.
ContributorsHickman, Carolyn (Author) / Melnyk, Bernadette M (Thesis advisor) / Jacobson, Diana (Thesis advisor) / Gance-Cleveland, Bonnie (Committee member) / Szalacha, Laura (Committee member) / Arizona State University (Publisher)
Created2012
Description
Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).
Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.
Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.
Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.
Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.
ContributorsMomberg, Heather (Author) / Jacobson, Diana (Thesis advisor)
Created2020-05-01
Description
Background: Health information technology (HIT) refers to the electronic health care systems organizations used to store, share and analyze healthcare information. A central component of the HIT infrastructure is an electronic health record (EMR) and although HIT has been shown to increase enthusiasm for patient care, decrease healthcare costs and improve patient outcomes overall utilization in the United States (US) remains low.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
ContributorsProsev, Brittany (Author) / Jacobson, Diana (Thesis advisor)
Created2020-05-01
Description
Objective: Delirium frequently occurs in Pediatric Cardiac intensive Care Units (PCICU) of hospitals with critically ill patients. An inflammatory process of the brain causes neurotransmitters imbalances and neuronal alterations, leading to increased days on mechanical ventilation, length of stay in the ICU, and possible self -harm. Delirium can be reduced and controlled if detected early through frequent patient monitoring and screening. The purpose of this project is to evaluate the implementation of a delirium screening tool along with education on delirium
Study Selection: An education module on delirium and the Cornell Assessment of Pediatric Delirium (CAP-D) screening tool along with a non-pharmacological bundle was implemented on a pediatric cardiac intensive care unit for patients 2 to 18 years of age, admitted to an Arizona metropolitan children’s hospital. All nurses were required to attend the education session. Data was collected by using pre- and post-survey questions on delirium for those nurses who chose to participate in the study.
Data Synthesis: The results from the pre- and post-tests suggest there was an increase in education. The average score for the 15 nurses on the pre-test was 87.1% while the same nurses scored 100% on the post-test. Chart reviews of the CAP-D screening tool from November 2000 – February 2021 had 71 patients on the unit and had 8 patients scored on the CAP-D screening tool. Chart reviews after implementation of the education module from November 2021 – February 2022, were conducted and 118 patients were on the unit while only 23 patients were scored on the CAP-D screening tool.
Conclusion: So far, the use of an education module and implementation of a non-pharmacological bundle has proven some promising results in helping with delirium and its reduction in the PCICU.
ContributorsHernandez, Ricardo (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Objective: To understand and prevent adverse discharge events, the project assesses the needs and gaps of discharge care coordination for child(ren) with medical complexities (CMC). The National Survey of Children’s Health show 87.4% of CMC does not receive care in a well-functioning system, and 47.4% did not receive adequate care coordination 1. Therefore, does initiating measurement tools and communication before and after discharge identify and prevent discharge related adverse events?
Methods: After IRB approval, a mixed-methods approach project occurred at southwestern pediatric free-standing hospital. Through eight weeks of convenience sampling, CMC caregivers were recruited in the inpatient setting (n=5). Qualitative and quantitative data were obtained through: [Pediatric] Care Transitions Measurement Tool – 15 (CTM- 15), with a Cronbach’s alpha of .932; a demographics survey; a post-discharge survey; and electronic health records.
Results: The CTM-15 post-discharge score was 83.3 (N = 4, SD = 9.83, SE¬M = 4.92). CTM-15 qualitative data included: communication issues; rushed discharge; poor discharge anticipatory guidance; hospital policy concerns; follow-up appointment issues; and prescription errors. LOS average for all participants was 137.8 days (SD = 102.75, SEM = 45.95) with 40 unintended hospital days (SD = 41.55, SEM = 18.51). Issues encountered 30 days post-discharge included: prescription errors, follow-up issues, and home health issues.
Conclusion: Hospitalized CMC have an increased risk to encounter a discharge adverse event because of a complex intertwining of disciplines, services, medications, and needs. Communication, tools, and surveys did not capture all the problems encountered by families with CMC; however, it did identify areas of notable concern.
ContributorsChalla, Hannah (Author) / Bucci, Aimee (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-05-02
Description
Objectives: Asthma education is essential for every pediatric asthma management plan. This Doctor of Nursing Practice (DNP) Quality Improvement (QI) project, guided by the Social Cognitive Theory, aims to explore effective and innovative interventions for asthma management and determine if telehealth is an effective way to deliver asthma education to parents.
Methods: Parents (n = 5) of children with asthma at an urban pediatric primary care clinic were recruited to attend four weekly, 60-minute asthma education sessions over Zoom®. Participants were recruited with flyers and clinic referrals. Participants answered pre- and post-intervention online questionnaires following informed consent, including the Parental Asthma Management Self-Efficacy Scale (PAMSES), the Asthma Control Test (ACT), and a parent program evaluation. Paired sample t-tests were conducted to analyze data and measure mean differences in pre-and post-parent self-efficacy and asthma control in their child.
Results: The results include a statistically significant change in pre-intervention and post-intervention mean PAMSES scores. There was no significant difference between pre-intervention and post-intervention ACT scores; however, there was an increase in mean ACT scores from baseline.
Conclusions: Telehealth is a practical and cost-effective way to address gaps in asthma education and improve patient outcomes. The use of telehealth may be an effective way to address gaps in parent/patient education regarding the prevention of and management of asthma symptoms. Ongoing assessment is needed to evaluate if asthma telehealth education can be effective in other settings, languages, and age groups.
ContributorsFlores, M. Cynthia (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
The purpose of this Doctor of Nursing Practice (DNP) project is to develop and implement a culturally tailored educational program into a community clinic in a northern border community in Mexico to prevent and combat childhood obesity. In Mexico, 33.2% of children are overweight or obese and numbers are continuing to rise, which has a significant impact on physical and psychological health and can lead to diabetes, fatty liver disease, thyroid disease, cardiovascular disease, cancer, depression, and other chronic diseases. Guided by Bandura’s theory of self-efficacy, weekly education sessions were delivered to members of the community clinic for two weeks. Content included both a nutrition component and an exercise component. An emphasis was made on increasing physical activity, increasing water consumption, decreasing sugar sweetened beverages, and increasing fruit and vegetable consumption. Videos were developed for each education session. Worksheets and handouts were developed to enhance learning and give participants a tangible reference for individual learning. Content was taken from the CDC and adapted to fit the needs of the community. All content was culturally tailored for low literacy levels and translated to Spanish. Knowledge, behavior change, and self-efficacy were measured by pre and post surveys. Self-efficacy showed statistically significant change from pre and post intervention. These findings suggest that healthy eating and exercise education can potentially increase knowledge, promote behavior change, and enhance self-efficacy, which can, in turn, prevent and combat childhood obesity and related disease states.
ContributorsBahena, Sara (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Background: Existing practice standards for discharge education are insufficient to support parents of children with new enteral feeding devices in the outpatient setting which has led to increased clinic and emergency department visits, hospital stays, and preventable complications. The purpose of this Doctor of Nursing Practice (DNP) project was to design and deliver a comprehensive evidence-based enteral feeding tube hospital-based discharge education intervention for parents after their child’s gastrostomy tube placement surgery. Guided by Transition’s theory, the project aims to bridge the gap in education by providing the parent with ongoing support and education about their child’s gastrostomy tube. Methods: This project measured the impact of inpatient discharge education with ongoing support and outpatient education on parent knowledge and confidence. All English-speaking parents of pediatric patients ages 0-17 years with new gastrostomy tubes at a large, urban, freestanding pediatric hospital in the southwest United States were eligible for participation. Institutional Review Board approval was obtained. Informed consent was obtained from all participants. The education intervention was delivered at hospital discharge then reinforced at the first follow-up visit in the surgery clinic. Data analysis included demographic items, a Paired Samples T-Test, and a Two-tailed Wilcoxon Signed Rank Test analyses. Results: Results indicated a statistically significant difference in parent knowledge after the educational intervention. Results also indicated a clinically significant increase in parent confidence. Conclusion: Providing ongoing support and education positively impacts parent knowledge and confidence related to the care of their child’s new gastrostomy tube. Future impacts of this educational intervention may demonstrate a decrease in clinic and emergency department (ED) visits, hospital expenditure, and preventable complications.
ContributorsFriedl, Anne (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Children with congenital heart disease (CHD) are at increased risk for psychosocial issues (PSI), decreased quality of life (QOL), and decreased resilience. The purpose of this project was to implement a screening protocol for PSI, QOL, and resilience, with appropriate psychosocial referral for children with CHD.
A pilot protocol was implemented to screen children with CHD, aged 8-17 years, and parents, for resilience, QOL, and PSI. Referrals for psychosocial services were made for 84.2% of children screened (n = 16) based on scoring outcomes. Statistically significant differences in the parents and children’s resilience mean scores were noted. Higher parental scores may indicate that parents believe their children are more resilient than the children perceive themselves to be.
Early identification of concerns regarding QOL, resilience, and PSI in children with CHD can provide ongoing surveillance, while affording opportunities for improved communication between providers, parents, and children. Routine screening and longitudinal follow-up is recommended.
ContributorsBonowski, Kelley (Author) / Jacobson, Diana (Thesis advisor) / Zangwill, Steven (Thesis advisor) / Espinoza, Jennifer (Thesis advisor)
Created2018-04-30