DNP Projects

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https://hdl.handle.net/20.500.12517/42

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Addressing Workplace Bullying Among Nurses at a Community Hospital
(2018) Downey Luhrmann, Susan
Bullying and incivility are forms of workplace violence (WV) that occur frequently in nursing. This violence is costly and detrimental to the nursing profession, healthcare organizations, and patients. Increasing awareness, education and addressing workplace bullying (WB) immediately and consistently deters the violence. This project included an educational intervention based on the American Nurses Association’s (ANA) Code of Ethics (COE) and was designed for staff registered nurses (RN) in non-management roles. The objectives were to measure the RNs’ perceived exposure to WB; and to measure the effectiveness of an online educational intervention on RNs’ awareness of responsibilities in addressing WB. A quasi-experimental design utilizing the Negative Acts Questionnaire Revised (NAQ-R) was used to measure RNs’ perceived exposure to WB. Knowledge of and responsibilities to address these behaviors were assessed and compared in the pre and post-survey. The Michigan Organizational Assessment Questionnaire (MOAQ) was used to measure RNs’ intent to leave their current position. Positive responses were elicited in all questions of the NAQ-R. Knowledge improved after the educational intervention by as much as 63%. The MOAQ revealed that over 40% of participants were likely to leave their current position for a new job within the next year related to WB. Addressing WB is crucial in preserving the integrity of the nursing profession.
Ashtanga Vinyasa Yoga For PTSD in a Veteran Population
(2017) Doyle, Kelly F MS, PMHNP-BC; Knight, Margaret PhD, PMHCNS
Objective: Posttraumatic stress disorder (PTSD) is a serious medical and mental health issue currently faced by many veterans. The number of veterans diagnosed with PTSD is rising quickly. Existing treatments have not proven to be fully effective. The purpose of this study was to test Ashtanga Vinyasa Yoga (AVY), a breath-based yoga intervention, designed to improve the symptoms of PTSD and sleep quality in a veteran population. Methods: This was a quasi-experimental pilot study. Sixteen veterans who screened positive for PTSD were assigned to a ‘yoga group (treatment)’ or a ‘waitlist yoga group (control).’ Assessments were conducted for both groups at pre-treatment and post-treatment. Differences in pre and post-treatment self-report symptom survey data were compared. Treatment group and non-treatment group pre and post-treatment scores were also compared. Outcome measures were the Posttraumatic Stress Disorder Checklist for the DSM-5 (PCL-5) and the Insomnia Severity Index (ISI). Intervention: The ‘yoga group’ was provided a one-month, eight-session, twice-a-week, 60-minute AVY intervention class adapted for all mobility levels. Results: At the conclusion of the study, 88% of the treatment group no longer met criteria for a provisional diagnosis of PTSD using the self-report PCL-5 and 88% no longer displayed moderate or severe clinical insomnia scores on the ISI. There was no change in the control group. Clinically significant reductions in the PCL-5 and ISI scores were shown in the treatment group. The control group showed no meaningful reduction in PCL-5 and ISI scores. Conclusions: Results of this study support existing evidence and demonstrate AVY
An Educational Intervention to Improve Knowledge and Communication Skills for Nurses
(2018) Regan, Eileen M. MSN, AGPCNP-BC, OCN
Background: The process of informed consent (IC) for clinical trials is based on historic events, federal regulations and ethical principles. Deficiencies in patient understanding of IC are taken seriously by the research community, yet research dedicated to find ways to improve patient understanding has yielded mixed results. Teach-back is an evidence-based tool recommended for use during IC discussions. Nurse role in the IC process is important, particularly for patient education and advocacy. Objective: Initiate and evaluate an educational program for nurses to improve knowledge and communication skills used in IC for cancer clinical trials. Methods: An educational program, including the history of IC for clinical trials, review of current literature, assessment of patient understanding and health-literacy, the role of the nurse, and teach-back as a communication skill was presented to nurses at a Northeast Cancer Center. Anonymous pre/post/one-month post surveys measured nurses’ knowledge of research and importance and confidence using teach-back during IC discussions. Findings: Nurses had high research knowledge scores and statistically significant improvement in pre/post-test scores of conviction and confidence using teach-back. Nurses employed essential elements of teach-back before the program, however had greater recognition of elements after the program.
The Effect Of An Educational Intervention To Improve Healthcare Professionals Attitude Towards People With Diabetes In Corrections
(2020) Thuo, William
Effectiveness of a Diabetes Education and Oversight Program to Improve Glycemic Control in Adults with Uncontrolled Type 2 Diabetes
(2019) Lepore, Justin E.
Purpose: The purpose of this pilot project was to measure the effectiveness of a diabetes education program that included close oversight of glycemic control amongst adults with uncontrolled type 2 diabetes. Methods: A pilot study using pre/posttest design was implemented over a 4-week period for each participant (n=11). A simplified version of the Michigan Diabetes Knowledge Scale was utilized to test diabetic knowledge in a True/False/Don’t Know format. Patient education utilized two handouts from the American Diabetes Association (ADA) and close oversight occurred through weekly telephone interviews of each participant. Results: Posttest scores from the Michigan Diabetes Knowledge Scale exhibited an 8.7-point mean increase from pretest scores (p=0.07). Total mean glucose (n=11) from week 1 demonstrated a decrease of 14.3 mg/dL (0.79 mmol/l) (p=0.25) by week 4 as pre-lunch glucose demonstrated a statistically significant decrease (p=0.01). Conclusions: Close oversight of individuals with type 2 diabetes may improve mean glucose averages in the fasting, pre-lunch, pre-supper, and bedtime states. Telephone encounters proved more effective over the use of educational handouts when participants were asked to compare the usefulness of both methods.
Enhancing Prescription Drug Monitoring Programs Knowledge and Intent for Use: A Provider Educational Approach
(2017) Bookman, Jeremy
The purpose of this pilot study was to assess and measure the impact of education to prescriber's regarding the use of a prescription drug monitoring program (PDMP); and further to assess for change in prescription provider’s perceptions and intent to utilize PDMP. Implementation of prescriber education, to increase knowledge and intent to use PDMP’s can assist in identifying and treating prescription misuse or abuse. A cross-sectional, pre and post, survey design was utilized to measure study objectives. Medication providers in a community psychiatric clinic that completed the effective approaches to reduce misuse or abuse of prescribed drugs program had a significant improvement in post-test perception and intent to use PDMP as compared to pre-test scores. Specifically, these results suggest post educational intervention prescriber's expected it was more likely than unlikely that they will use the PDMP in the next three months compared to pre intervention.
Evidence-Based Practices to Improve Monitoring for Surgical Patients with Obstructive Sleep Apnea
(2020) Fotino, Karen L.
Introduction: Patients who have obstructive sleep apnea (OSA) are at higher risk for opioid-induced respiratory depression postoperatively. Many patients who have OSA are not diagnosed before having surgery and may not be monitored appropriately postoperatively. Purpose: The purpose of this quality improvement project was to increase the number of preoperative patients screened for OSA and improve their postoperative monitoring through a novel OSA Protocol order set. Methods: Screening for OSA risk is performed preoperatively using the STOP-Bang instrument. High-risk patients, as well as patients with existing OSA, are monitored postoperatively using a bundle of evidence-based practices to identify early respiratory compromise. If respiratory events occur, a treatment intervention will be triggered. Outcome: Post-intervention chart reviews demonstrated 100% of the qualifying patients had OSA screening completed prior to surgery. The OSA Protocol was ordered for 28 patients. Patient harm may have been avoided through the use of continuous positive airway pressure (CPAP) triggered by actual respiratory events. Conclusion: It is important to identify patients before surgery through preoperative screening. Identified patients should be monitored closely postoperatively for the detection of early respiratory compromise. A standing order for CPAP for patients with respiratory events can provide treatment rapidly to optimize patient outcomes. The process for monitoring high-risk patients on this postoperative unit could be considered for replication on surgical units in other hospitals.
HEPATITIS C SCREENING, DIAGNOSIS AND FOLLOW-UP CARE
(2018) Flynn, Constance Mary
Chronic Hepatitis C Virus (HCV) infection causes more deaths than all infectious diseases combined. Direct acting antivirals (DAAs) may cure over 90% of HCV infections. The Center for Disease Control (CDC) recommends screening high risk and baby boomer birth cohorts (CDC, 2015a). Those testing positive for HCV antibodies require HCV RNA to confirm infection. Positive HCV RNA necessitates follow-up with a primary care provider (PCP) or HCV specialist. This project was designed to determine if educating a group of PCPs on CDC HCV testing sequence would improve diagnosis and follow-up care. An educational presentation on CDC HCV guidelines was provided to group of PCPs. Rates of HCV screening, diagnosis and follow-up appointments were collected three months pre/post intervention. Descriptive statistics were used to compare rates of HCV screening, RNA confirmation and follow-up care. Although pre-post screening rates were nearly identical with all HCV positive patients receiving confirmatory diagnosis and follow-up, the overall project impact was not anticipated. The end result led to automated reflex HCV RNA confirmatory testing, formation of a hospital/ community task force to examine HCV treatment access, and establishment of a hospital based HCV clinic. In addition, there were multiple HCV educational presentations for providers and allied health personnel. There was increased local media attention (television, newspaper) on the HCV epidemic, which improved community awareness of the need for HCV screening and treatment.
Improving self-efficacy of heart failure patients with low health literacy by providing nutritional infographics
(2020) Reddy, Sarah
Heart failure (HF) is considered one of the costliest health epidemics in the U.S. Research has shown that there is a direct correlation between health literacy, HF knowledge and overall health outcomes. Approximately one in three Medicare patients have low health literacy. The population chosen for this project were enrolled in a program called, PACE (program of all-inclusive care of the elderly). The program supports frail Medicare and Medicaid patients living independently in the community. The objective of this project was to evaluate the effectiveness of providing individuals with low health literacy infographics to help improve their self-efficacy and management of their HF. Instruments used included the Self-Efficacy for Managing Chronic Disease (SEMCD) 6-item Scale and UR What U Eat. The latter tool is a color-coded infographic depicting sodium content in food using green for ‘go’, or little to no sodium content, yellow for ‘slow’, or low to medium sodium content and red for ‘whoa, which indicates that the food is very high in sodium. This pilot project used an experimental design which involved a pre and post self-efficacy evaluation survey, weekly weight tracking and weekly coaching. Data were analyzed using a paired sample t-test. Results suggest that providing nutritional infographics to participants and weekly weight monitoring led to a significant improvement in their self-efficacy and ability to manage their heart failure. Increasing self-efficacy can lead to improved health outcomes, patient satisfaction and a reduction in hospital admissions.
Increasing Awareness of Hypertension Management in African American Population Originally from Cameroon. A Group Educational Intervention
(2019) Benazea, Abila, DNPc, MSN, CNP
Hypertension is a significant, global public health concern. An educational intervention one-group, pre-test/post-test, was conducted in an African American community social group to improve awareness and knowledge. Thirty-nine individuals participated and completed the pre and posttest on hypertension knowledge. The mean age was 43.15 years, age range 28-60. For the overall study, there was a significant difference in participant’s pre-intervention knowledge (M=25.3; SD. =2.7) and post-intervention hypertension knowledge (M=22.8; SD.85); t (39), p<0.001. Effective community education considers cultural background and social norms, hypertension knowledge and awareness is particularly critical for the African American community.
An Intervention to Increase HPV Vaccine Initiation Rates in Adolescent Males
(2018) Marchand-Ciriello, Lisa
Abstract Introduction: In 2016, the Centers for Disease Control and Prevention reported the average Human Papillomavirus, (HPV) vaccine initiation rate among males was 50% versus 63% for females. The objective of this project was to increase HPV vaccine initiation rates among males aged 11-21. Methods: Quasi-experimental design investigated pre-and post-HPV vaccine initiation rates at a pediatric practice that serves a diverse population. The intervention included an electronic medical record (EMR) prompt, an educational presentation, and monthly email updates to providers. De-identified HPV vaccine initiation rate data were collected, pre-and post-intervention and matched with providers. Results: A paired two-sample t-test evaluated differences in pre-post vaccine initiation rates. HPV vaccine initiation rates increased overall by 6.5% during the twelve-week project period. The EMR prompt was favored by 75% of participating pediatric providers. Discussion: Small gains can be made over a short period of time to improve HPV vaccine initiation rates among adolescent males. Keywords: HPV Vaccine and Males, Intervention and HPV Vaccine, Provider Barriers and HPV Vaccine Rates.
Move to Improve; a Pilot Project to Evaluate Restorative Mobility Interventions in Older Adult Veterans
(2020) Saindon, Kelly
Background: Physical function deterioration can occur rapidly for older adults who are discharged from intensive therapy. This problem has serious implications due to the amount and the high cost of medical care and potential health risks associated with decreased mobility. Move to Improve was a pilot quality improvement project that evaluated how effective an integrated restorative nursing intervention was at attaining or maintaining the highest physical, mental, and psychosocial well-being of older adult Veterans who have transitioned from intense therapy to long term care. Methods: A sample of ten geriatric Veterans were engaged in biweekly mobility group activities as well as issued activity trackers to increase engagement and collect mobility data. Pre-post test assessment using two subcomponents of the Barthel Index were used to measure mobility and transfer. Results: Eight out of nine (89%) Veterans who completed the 6-week restorative intervention maintained or increased functional status. Conclusion: The Move to Improve program effectively maintained functional status. The Veteran participants reported having no prior experience with wearable technology but use of the activity trackers engaged them in tracking their progress. The outcome of this quality improvement pilot project provides a foundation for future research.
Passive Monitoring of Physical Activity Using a Fitbit Charge 3 in Individuals at Risk for Depression
(2020) Santomas, Kelly
Purpose: The purpose of this study was to measure the effectiveness of using an activity tracker, Fitbit Charge 3, on depression scores and physical activity scores in individuals at risk for depression. Design: This was a pilot project that passively monitored step count activity using a Fitbit Charge 3 over an 8-week intervention period in individuals who were at risk for depression. Individuals were screened for depressions risk using the patient health questionnaire-2 (PHQ-2). Methods: Individuals were recruited from a convenient sample. Selection criteria was limited to adults ages 18-69 with a score >1 on the patient health questionnaire-2 (PHQ-2) indicating risk for depression and who owned or had access to a smartphone. Upon enrollment, individuals completed the patient health questionnaire-9 (PHQ-9), the international physical activity questionnaire (IPAQ) and were issued a Fitbit Charge 3. Individuals were asked to wear their Fitbit Charge 3 for 8 weeks. Step count data was automatically uploaded into the individual’s electronic health record (EHR) every 24hrs via Bluetooth integration with the Fitbit Charge 3. At the end of the 8 weeks, individuals completed the PHQ-9 and IPAQ. Step count data was downloaded from the EHR at the end of the intervention. Results: Individuals with lower PHQ-9 scores had higher IPAQ scores and higher step counts. These individuals indicated they would continue to use the Fitbit post study. In most individuals, PHQ-9 scores decreased from baseline while IPAQ scores increased. Overall step count peaked at week 5, then decreased but stayed above baseline. Conclusions: Physical activity is an important component for mental and physical wellbeing. Using commercially available devices can provide clinicians an important tool in encouraging patients to engage with improving their overall health.
Reminiscing Groups: Promoting Mental Health Among Older Adults
(2017) Furey, Diane;
Depression is a major health problem among older adults. The objective of this study was to examine the effectiveness of a reminiscing group (RG) for the improvement of depression and loneliness symptoms of long term care (LTC) residents 65 years old or older. A randomized controlled interventional study was implemented. Twenty LTC residents were randomly assigned to either a reminiscing group or a waitlist control group (WCG). Measurement tools included pre/post Geriatric Depression Scale (GDS) and University of California, Los Angeles (UCLA) Loneliness Scale. SPSS 24 statistical package was used to analyze the data. The results of this study suggest a positive short- term effect of depression and loneliness in this sample. Implementing reminiscing groups as an intervention in LTC facilities could improve depression and loneliness symptoms in older adults.
STOP-Bang Questionnaire Screening for Sleep Apnea Treatment In An Outpatient Surgical Center
(2017) Burns-Mullet, Cheryl Ann; Zhang, Yuan
Background: Sleep apnea is often undiagnosed, increasing in prevalence and contributes to anesthetic risk. Sleep apnea is associated with hypertension resistant to treatment, cardiac arrhythmias and stroke. It is critical for anesthesia providers to use the STOP-Bang Questionnaire to screen patients for sleep apnea risk factors and severity and to develop a care plan which will lead to a safe anesthetic outcome. Purpose: This study used the STOP-Bang Questionnaire pre-operatively to screen, identify and educate patients about their sleep apnea risk factors. The objectives of this study were to examine the effect of sleep apnea screening on patients’ decisions regarding further evaluation of sleep apnea with PCPs and Sleep Medicine Practitioners, as well as identify facilitators and barriers to further evaluation. Methods: Patients at an outpatient surgical center were screened by an anesthesia provider with the STOP-Bang Questionnaire. Patients with STOP-Bang scores equal to or greater than 3 were educated and instructed to follow-up with their Primary Care Provider. Each patient received a copy of their completed questionnaire and information from www.stopbang.ca describing the long-term health effects of untreated sleep apnea. Patients consented to have the anesthesia provider notify their PCPs regarding their sleep apnea risk factors. The researcher followed up with patients in three months to determine whether patients sought further evaluation and treatment for sleep apnea. Results: Thirty two patients with scores > 3 agreed to participate. Fifteen patients discussed sleep apnea risk with their PCPs within 3 months, among whom, 9 patients consulted Sleep Medicine Practitioners and completed sleep studies. Of these 15, four patients PCPs did not think their patient needed to have a sleep study. The remaining 2 patients who visited the PCP did not want to follow thru with the sleep study even though the PCP recommended that they do. Eight patients from the original sample of 32 intended to discuss sleep apnea during their next scheduled visit with their PCPs. The remaining 9 patients gave various reasons for lack of follow- up with their PCPs. Conclusion: Sleep apnea is widely undiagnosed and few providers screen patients for sleep apnea. STOP-Bang screening and education at the outpatient surgical center can help identify sleep apnea risk factors and encourage patients’ further evaluation and treatment of sleep apnea.

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