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- Creators: Nunez, Diane
- Member of: Doctor of Nursing Practice (DNP) Final Projects
Implementation of a Suicidal Ideation Treatment Algorithm in a Military Medicine Primary Care Clinic
Description
Primary care providers (PCPs) are frequently the first line of treatment for suicidal ideation (SI) patients. Many PCPs report low self-efficacy in treating suicidal patients, leading to inappropriate treatment plans or avoidance of discussing SI. This quality improvement project based on the Uncertainty Reduction theory aimed to evaluate PCP's perceptions of an SI treatment algorithm and its impact on self-efficacy. Secondary aims included assessing PCP's confidence in treating suicidal patients and current treatment practices. A pre- then post-intervention survey design was utilized. All PCPs treating patients in a military medicine clinic were invited to participate in the project. Participants were sent a recruitment email containing the suicidal ideation treatment algorithm and a link to a survey developed with Qualtrics software. Participants were asked to review the SI algorithm, answer the baseline survey questions, and complete a second eight-week survey. For human subjects' protection, the survey responses were anonymous. Demographic data collected included years of clinical experience and licensure type. The data were evaluated with Intellectus software. Due to limited participation, N=4, there was insufficient data to determine the significance of implementing the SI algorithm in a primary care clinic. Central tendencies showed that most providers (n=3, 75.00%) felt less than confident treating suicidal patients. Half of the providers asked non-mental health patients about suicide less than 40% of the time (n=2, 50.00%). The data suggest that PCPs feel uncomfortable treating suicidal patients and may benefit from additional resources and training in this area.
ContributorsGale, Mianna (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-26
Description
Introduction: Electronic cigarettes (e-cigarettes) among youth has increased drastically in recent years. E-cigarettes are being used with nicotine which can lead to dependency. Healthcare providers (HPs) are in a unique position to advise against the use of e-cigarettes. Recent studies report a lack of formal education among HPs about e-cigarettes. The purpose of this quality improvement project is to examine how increasing e-cigarette awareness among HPs can change their behavior on patient counseling against e-cigarette use. Methods: A modified E-cigarette Knowledge, Beliefs and Attitude Questionnaire was proctored before and after a virtual educational training about e-cigarettes. All advanced HPs employed, in a Southwestern state, at the organization were invited to participate by email. Results: 29 participants completed the pre-survey, and 4 participants completed the post-survey. While 90% of the participants reported that they first learned about e-cigarettes through informal sources, 72% of the participants reported interest in learning more about e-cigarettes to enhance their practice. Further, a two-tailed Mann-Whitney U test was significant on the “e-cigarettes are helpful aid for smoking cessation” statement based on an alpha value of 0.05, U = 12, z = -2.69, p = .007. Conclusions: Increasing the knowledge about e-cigarettes among HPs is critical in decreasing nicotine use among the public. This project will help in the fight against the use of tobacco products, and adds to the literature on how formal education about e-cigarettes among HPs can increase their intention to screen and counsel patients.
ContributorsWelch, Analuisa (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-01
Description
Objective: Substance use disorder (SUD) is an epidemic in the United States. Current standard of care for SUD continues to produce a 40-60% relapse rate. Treatment for SUD is costly and is not obtainable for many individuals. The purpose of this project is to implement mindfulness as an adjunct treatment for SUD to reduce relapse.
Methods: Voluntary program offered at a residential treatment center designed as a team-based project. The combined project includes exercise, wellness, and mindfulness. Adults over the age of 18, male or female with a diagnosis of SUD were eligible. Program consisted of three hourly sessions a week, for a total of three weeks. Sessions included one session of exercise and wellness, one session of mindfulness training, and a combined session. Mindfulness sessions included learning the seven pillars of mindfulness followed by guided meditation. Participants were given a mindfulness journal for daily exercises. Five Facet Mindfulness Questionnaire (FFMQ) was completed before program and on completion. Results: 11 of 22 participants completed the program. FFMQ total scores were analyzed with paired t-test with Wilcoxon signed rank to account for small sample size. Statistical significance was based on an alpha of 0.05, V=10.50, z=2.00 and p=0.45.
Conclusion: This project has the potential to decrease relapse rates by increasing mindfulness in individuals with SUD. Mindfulness training reduces cravings and negative thought processes. Implementing mindfulness training with current standard of care can be cost effective and recommended for all individuals with SUD.
ContributorsRouston, K. Courtney (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-01
Description
Background: Current standard of care practices for substance use disorder is inadequate in reducing relapse, with rates persistently 40-60% within one year of treatment. Unconventional approaches must be explored to reduce the risk of relapse, climbing rate of overdoses, and healthcare expenditures exceeding $740 billion annually. The purpose of this quality improvement project demonstrates how an evidence-based group exercise intervention, used as adjunctive support to standard addiction treatment, can reduce relapse and promote long-term recovery during a global pandemic. Methods: Aims of this project sought to enhance quality of life scores. Participants were recruited upon admission to a residential treatment center. Pre-posttest design utilized the World Health Organization Quality of Life Abbreviated scale to assess program impact on quality of life. Pre-program descriptive questions and a survey assessing prior addiction treatment were collected. Group exercise and wellness education sessions were delivered twice weekly in a live, interactive, virtual format with on-site participants. Upon completion, a post-program survey was utilized to capture the qualitative experiences of participants and impact of project to instill confidence to execute long-term sobriety. Results: Pre and post scores, as well as domain scores were clinically and statistically significant. Additionally, 80% of participants reported feeling more prepared to achieve long-term sobriety secondary to their participation in this project. Discussion and Conclusion: Results from this project demonstrate the positive impact that group-based exercise and lifestyle interventions can have on quality of life and long-term recovery. Peer support exercise programs may offer means to enhance addiction treatment and reduce overall healthcare expenditures globally by defying the odds of relapse.
ContributorsAvino, M. Hayley (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-05-01
Description
Objective: Obesity is the fifth leading cause of global death and is preventable. It affects all body systems and causes major chronic illnesses such as diabetes, heart diseases, stroke, and some cancers. The goal of this transtheoretical stages of changes (TSOC) theory-based project are as follows: To educate the participants of the project to be aware of obesity and its complications; motivate them to use community resources, and improve their body mass indexes (BMI), waist circumference (WC), motivation, quality of life (QOL) and lifestyle.
Methods: Twenty-three participants were recruited in a primary care clinic. Six participants dropped out during the project. All the randomly selected participants who met the criteria of obesity signed written informed consent and were provided a 4-digit code to maintain anonymity. Participants were motivated and educated using a handout, two pre-and post-project in-person nursing visits, and five telemedicine weekly nursing follow-ups visits. Pre- and post-surveys collected during in-person visits include data such as weight, BMI, WC, demographic data, comorbidities, lifestyle, motivation, QOL, TSOC, and utilization of community resources.
Results: Descriptive analysis and paired t-test is done utilizing Intellectus statistics software to measure the outcome. The results show improvement in dietary choices, physical activity, motivation, QOL, use of community resources, decrease in BMI, and WC. In paired t tests, results show clinical and statistical significance in BMI, WC, MOT and clinical significance in QOL. There was increase in the revenue at the project site due to reimbursement of the services provided for the patients.
Conclusion: The results are expected to develop practice change in preventing and treating obesity. More evidence-based projects and studies with large sample size are needed to develop improvement in the knowledge base of providers and current practice.
ContributorsCherian, Ribi (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-28
Description
Background: Existing substance use disorder guidelines are deficient in reducing relapse rates, evidenced by the substantial number of persons experiencing relapse within months of recovery, with most relapsing within one year. Current interventions lack community reinforcement approaches to reduce relapse and risk factors required to combat the extensive damages related to substance use as costs exceed $1 trillion annually. Guided by the Social Cognitive Model, this quality improvement project aims to explore how group exercise combined with community reinforcement reduces relapse. It aims to boost recovery capital by improving quality of life scores. Methods: A CrossFit instructor delivered personalized group exercise and wellness education in-person biweekly for six weeks. Adult residential treatment clients were eligible to participate recruited via a flyer upon treatment entry. A pre-intervention demographic questionnaire, a pre-/post World Health Organization Quality of Life Abbreviated scale (reliability ? = > 0.70) assessing intervention influence on the quality of life, and a post-intervention survey was administered. The lead investigator performed all data distribution and collection. Institutional Review Board approval safeguarded participants' rights and risks. Results: Pre/post improvements observed in all domains; psychological and environmental were statistically significant, while 100% of participants reported enhanced QoL, social support, & confidence related to long-term sobriety post-intervention. Discussion/Conclusion: Desired outcomes are increased quality of life scores to boost recovery capital. A sober community reinforcement approach combined with exercise may link to reducing relapse and total costs related to this growing public health crisis.
ContributorsChrapczynski, D. Alison (Author) / Nunez, Diane (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-30
Description
Background: Sepsis is a potentially life-threatening infection affecting millions of individuals. Nearly three million individuals are affected annually, killing one in every two to four individuals. Sepsis mortality rates are highest in those 65 and older, making it the most expensive diagnosis paid by Medicare and worldwide at $24 billion dollars. Early goal directed therapy (EGDT), created by the International Surviving sepsis campaign, is a bundled protocol created to decrease mortality rates, however, utilization and completion remains a problem in the emergency department (ED).
Purpose: This project sought to evaluate the gap that exists between best practice and current practice, for sepsis identification and EGDT implementation.
Methods: The project was completed over a four-month period with prior Institutional Review Board (IRB) approval and consisted of evaluation of sepsis knowledge and barriers to EGDT. Questionnaires included demographics, sepsis knowledge, barriers to EGDT and AHRQ quality indicators toolkit.
Results: Sample (N=16) included registered nurses (RN) and healthcare providers. Descriptive statistics were utilized for evaluation of questionnaires. Results indicate staff have sound understanding of signs and symptoms of sepsis, however application through case studies demonstrated lower performance. Overall system barriers were minimal, with greatest barriers in central line monitoring and staff shortages. High level unit teamwork exists within the ED, however collaboration is lacking between ED staff and upper management. Results demonstrate moderate disengagement between upper management and staff leading to miscommunication. Recommendations included increased, consistent sepsis education, utilization of Institution for Healthcare Improvement (IHI) triple aim framework for evaluating systems, implementing a closed loop approach to communication, and having a staff champion for sepsis be included in meetings with upper management.
Purpose: This project sought to evaluate the gap that exists between best practice and current practice, for sepsis identification and EGDT implementation.
Methods: The project was completed over a four-month period with prior Institutional Review Board (IRB) approval and consisted of evaluation of sepsis knowledge and barriers to EGDT. Questionnaires included demographics, sepsis knowledge, barriers to EGDT and AHRQ quality indicators toolkit.
Results: Sample (N=16) included registered nurses (RN) and healthcare providers. Descriptive statistics were utilized for evaluation of questionnaires. Results indicate staff have sound understanding of signs and symptoms of sepsis, however application through case studies demonstrated lower performance. Overall system barriers were minimal, with greatest barriers in central line monitoring and staff shortages. High level unit teamwork exists within the ED, however collaboration is lacking between ED staff and upper management. Results demonstrate moderate disengagement between upper management and staff leading to miscommunication. Recommendations included increased, consistent sepsis education, utilization of Institution for Healthcare Improvement (IHI) triple aim framework for evaluating systems, implementing a closed loop approach to communication, and having a staff champion for sepsis be included in meetings with upper management.
ContributorsLevering, Miriam (Author) / Nunez, Diane (Contributor)
Created2018-04-30
Description
Purpose: To assess study participants behavioral responses and perception of effectiveness of an activity tracking device to increase physical activity. Obesity is an endemic health issue in the U.S. and continues to gain concern for increasing morbidity and mortality rates. Benefits of physical activity are firmly established across healthcare disciplines to combat and prevent obesity, yet sedentary behaviors continue to be on the rise. The use of wearable technology, that provides real-time feedback of activity, has been identified as a promising tool for increasing physical activity.
Methods: Analysis of a subset of questions from a larger survey was used to evaluate wearable device attitudes and behavior changes over time. Convenience sample (n=10), ages >18, required enrollment in a clinic-based weight and wellness program (WWP) to participate. The survey questions assessed effectiveness of wearable device on a 0-10 motivation scale to increase physical activity and a self- assessment of behavioral changes at specific intervals over a 6-month period. Descriptive statistics and non-parametric, two-tailed tests will be used to analyze the data. Due to the necessity of detecting minute differences with the small sample size, the significance level will be tested at the p<0.10.
Results: Participants >18 years of age, enrolled in a WWP (n=10) included 20% male and 80% female. Although a 12.3% increase in the mean score was found from week-1 to 6-months, the results were not statistically conclusive to the effectiveness of self-motivation to increase activity by participants wearing an activity tracking device; however, results are statistically significant for participants to increase activity with behavior changes based on device dashboard.
Conclusions: It is recommended for primary care providers to encourage the use of an activity tracking wearable device for behavior change to increase activity.
Methods: Analysis of a subset of questions from a larger survey was used to evaluate wearable device attitudes and behavior changes over time. Convenience sample (n=10), ages >18, required enrollment in a clinic-based weight and wellness program (WWP) to participate. The survey questions assessed effectiveness of wearable device on a 0-10 motivation scale to increase physical activity and a self- assessment of behavioral changes at specific intervals over a 6-month period. Descriptive statistics and non-parametric, two-tailed tests will be used to analyze the data. Due to the necessity of detecting minute differences with the small sample size, the significance level will be tested at the p<0.10.
Results: Participants >18 years of age, enrolled in a WWP (n=10) included 20% male and 80% female. Although a 12.3% increase in the mean score was found from week-1 to 6-months, the results were not statistically conclusive to the effectiveness of self-motivation to increase activity by participants wearing an activity tracking device; however, results are statistically significant for participants to increase activity with behavior changes based on device dashboard.
Conclusions: It is recommended for primary care providers to encourage the use of an activity tracking wearable device for behavior change to increase activity.
ContributorsCarroccio, Tanya (Author) / Nunez, Diane (Thesis advisor)
Created2018-04-28
Description
New graduate nurse practitioners and physician assistants, also known as advanced practice providers (APPs), face a significant number of challenges when entering professional practice. If the new graduate does not receive sufficient guidance and support during this transition to practice (TTP), they will likely experience significant psychological stress and anxiety. If an organization does not implement measures to address TTP, the new graduate is much more likely to leave the current position within the first two years of practice.
An extensive literature review was conducted investigating the effects, and necessary components of an orientation program which supports the new graduate through TTP. Using Van Maanen & Schein’s (1979) Theory of Organizational Socialization, a comprehensive new graduate orientation program was designed and implemented in large multi-specialty practice. Initial results suggest that this program improves both the perceived organizational support felt by the new graduate, as well as the new graduates’ affective commitment to the organization. Improvements in both these dimensions have been shown to decrease turnover intention and increase retention of the employee.
ContributorsDean, Amanda (Author) / Porter-O'Grady, Tim (Thesis advisor) / Nunez, Diane (Thesis advisor)
Created2017-04-29
Description
One in every three deaths in the United States results from cardiovascular disease (CDC, 2013). Cardiovascular Rehabilitation (CR) is a medically supervised program designed to help improve cardiovascular health for patients who have experienced heart attack, heart failure, angioplasty, or heart surgery (AHA, 2016). A hospital in the southwestern region of the United States of America reports their 2016 CR attendance rate of 79 %, which is much lower than the national average of 94% (AACVPR, 2016). Motivational interviewing (MI) is a proven method used to promote a positive behavior change for cardiac rehab patients. MI includes quality improvement activities such as peer support and cardiac rehab educational classes that have shown to increase health related quality of life measures and decreased depression symptoms (Pietrabessa et al., 2017; Pack et al., 2013).
Despite all the knowledge about CR and its benefits for health nationally, there are low attendance rates, therefore the purpose of this evidence-based project is to improve CR attendance rates using MI. Patients enrolled into CR participated in the motivational interviewing for eight classes. At the end of the class, they were given notecards to create Specific Measurable Achievable Realistic and Timely (SMART) Goals for themselves for that week. The measurement tools, the PHQ-9 and Dartmouth COOP is a simple, reliable, and valid tool for assessing functional status of cardiac patients and the current CR program utilizes this tool and is familiar with explaining this tool (Eaton, Young, Fergussion, Garrett, & Kolbe, 2005).
A Pearson correlation coefficient was calculated for the relationship between the MI classes and the CR attendance, depression scores, and quality of life. A strong positive correlation was found (r (82)= .456, p< .001) indicating a significant linear relationship between motivational interviewing and cardiac rehab attendance. A weak correlation that was not significant for depression symptoms and quality of life. The impact of this evidence-based project is to give cardiac rehab programs further evidence that the implementation of motivational interviewing can positively influence cardiac rehab attendance rates.
ContributorsKungu, Wairumu (Author) / Nunez, Diane (Thesis advisor)
Created2019-05-20