Matching Items (296)
Filtering by
- Member of: Doctor of Nursing Practice (DNP) Final Projects
- Member of: MLFC Learning Futures Collaboratives Collection
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
Purpose & Background: Family Nurse Practitioner (FNP) residency programs are meant to ease providers' transition into practice, but there is limited evidence about their overall effectiveness and impact on provider satisfaction. When a FNP residency program in the Southwestern United States found they had high resident provider attrition rates, it prompted an investigation into current and past residents’ satisfaction levels.
Methods: Arizona State University’s (ASU’s) Institutional Review Board (IRB) and the project site’s review committee approved the project design for human subject protection. After approval, all current and past residents employed at the practice were e-mailed a link to SurveySparrow with the Misener Nurse Practitioner Job Satisfaction Scale (MNPJSS) and a demographic questionnaire in December 2021 and February 2022.
Results: Mean satisfaction scores indicated “minimally satisfied” overall. When satisfaction was compared over time using a two-tailed independent t-test for an alpha value of 0.05, p = 0.731, indicating no significant change in satisfaction over two months. Total satisfaction and subscales of satisfaction were divided by cohort, averaged, and compared on a Likert scale from “1” (Very Dissatisfied) to “6” (Very Satisfied). Current residents’ average satisfaction score was M = 3.77. They were most satisfied with challenge and autonomy, M = 4.28, and least with collegiality, M
= 3.26. Providers' one-year post-residency average satisfaction score was M = 3.98. They were most satisfied with benefits, M = 4.53, and least with time, M = 3.04. Providers' two-year post- residency average satisfaction score was M = 3.49. They were most satisfied with benefits, M = 4.56, and least with time, M = 2.90. Using Pearson Correlation tests there was no correlation between average satisfaction and average performance on Uniform Data Systems (UDS), r = 0.01, p = 0.968.
Conclusions: Overall providers were “minimally satisfied.” Opportunities to make program improvements were identified and could help improve retention and reduce costs and provider shortages.
ContributorsLuedtke, M. Erin (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Purpose: Patient portals are widely available online applications with many health-related tools that facilitate patient engagement and enhance communication with providers yet are highly underutilized. The purpose of this evidence-based practice (EBP) project was to explore an English and Spanish patient portal educational video's impact on patient engagement in a Federally Qualified Health Center (FQHC). The social cognitive theory underpins the project because patients' portal use behavior can change if changing their environmental factors in the clinic with educational videos.
Methods: The Universities Institutional Review Board granted exempt approval to ensure human subject protection. The participants included bilingual adult patients in an FQHC who have access to the internet and email addresses who visited the center during the implementation period. The tablets in the patient rooms displayed the English and Spanish educational video on step-by-step instructions on accessing, using the patient portal, and the benefits of use. The information technology technician pulled aggregate data from the analytics component of the patient portal before and after the four-week implementation period. The data included total number of clinic patients, number of active portal users, number of monthly logins, and gender. The project facilitator used descriptive statistics to compare pre-and post-intervention analytics. Results: Active portal users increased by 0.22% and monthly logins increased by 390 logins.
Only aggregate data was collected so the statistical significance was not calculated. Conclusion: This EBP project enhances knowledge on patient portal utilization's impact on patient engagement and may apply to current practice.
ContributorsHerrera, M. Sara (Author) / Ochieng, Judith (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2022-04-29
Description
Purpose: To assess the burnout levels of mental health workers and to evaluate the effectiveness
of promoting self-care practices in improving their well-being and resiliency.
Background and Significance: Burnout is highly prevalent among mental health workers due to
the nature of their work and the population of patients they serve. Turnover has been a
significant problem within this specialty for decades. Before the COVID-19 pandemic, the
mental health workforce was projected to experience shortage by 2025. The pandemic will likely
worsen this. Evidence from literature supports the effectiveness of promoting self-care towards
the development of resiliency and well-being in addressing burnout among healthcare workers.
Methods: The Maslach Burnout Inventory – Human Services Survey (MBI-HSS) was used to
assess the burnout levels of mental health workers in a psychiatric hospital in Arizona pre- and
post-intervention. Educational modules were provided for each participant to review. They were
asked to perform at least one self-care activity and to utilize the tools in the Provider Resilience
application every week for four weeks.
Results: Pre-intervention surveys indicated moderate levels of emotional exhaustion (m=20.71)
and depersonalization (m=9.29) and high levels of personal accomplishment (m=28.71).
Improvements were seen on emotional exhaustion (m=18.86), depersonalization (m=6.43), and
personal accomplishment (m=33.86) were seen post-intervention.
Conclusion: Although the results were not statistically significant due to small sample size, the
improvements seen on two out of three components of burnout (emotional exhaustion and
depersonalization) indicated that awareness of burnout levels and self-care practices contribute to
improving the well-being of mental health workers.
ContributorsLim, Jerica Elaine M. (Author) / Guthery, Ann (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Extracorporeal membrane oxygenation (ECMO) is a high-risk, but highly successful intervention for the survival of critically ill neonatal and pediatric patients. Patients supported by ECMO require continuous infusions of anticoagulant medications to prevent clotting of the ECMO circuit, thrombotic events in the patient, and other bleeding complications. Close monitoring, care, and management of the ECMO circuit and its components, with specific focus on systemic anticoagulation, is vital as many factors may influence the efficacy of the anticoagulant and ultimately the patient condition. Globally accepted guidelines exist for the correct management of anticoagulation while supported on ECMO; however, health care centers frequently deviate from these recommendations. This project report synthesizes the most current literature on anticoagulation management in the pediatric ECMO supported population, discusses the limitations in current research, and demonstrates the necessity to use standardized anticoagulation protocols for the safest and most successful outcomes. To implement these findings, this project report suggests the need for an evidence-based project that focuses on the quality improvement of current ECMO anticoagulation guidelines.
ContributorsHolmes, Lauren Michelle (Author) / Sebbens, Danielle (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Due to complexities surrounding healthcare for the homeless, continuity of care is virtually nonexistent. Continuity of care refers to individualized, comprehensive health care services that are timely, accessible, and coordinated. Health care continuity has been demonstrated to reduce mortality and improve health outcomes. A literature review determined access to mobile phones could improve health care continuity among homeless individuals. LifeLine is a state and federal program providing free phones and phone service to impoverished Americans. Enrollment into LifeLine can be challenging for the homeless, who lack access to even the most basic necessities. A project was developed to assist homeless individuals with enrollment into LifeLine in order to increase mobile phone access and improve care continuity. For four weeks, LifeLine enrollment assistance was offered to homeless clients of a mobile health outreach organization in San Francisco, California. Original, anonymous pre- and post-intervention surveys were administered to collect data regarding phone access and healthcare utilization patterns among this population. All 13 participants endorsed mobile phone access; only one participant completed enrollment into LifeLine. Seventy percent of participants reported health care continuity was directly improved by phone access, endorsing consistent healthcare visits and low hospitalization rates. Ninety-two percent of participants reported preexisting awareness of LifeLine, which likely contributed to low program enrollment. This project yielded clinically significant results indicating access to mobile phones can improve health care continuity for the homeless. Improving health care continuity for this population has both ethical and economic implications and remains a public health priority.
ContributorsHaug, Hailey (Author) / Harrell, Liz (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Purpose: Understanding the factors impacting communication between residents and peer staff in peer-run residential substance abuse treatment programs. The purpose of this paper is to explore male survival behaviors and cultural norms such as no snitching that impede communication to prevent relapse. Methods: The sample was male residents accepted into a residential treatment facility in the southwestern United States. Stories of peer-staff’s personal struggles with the no snitching code videotaped and shown in group followed with a guided discussion of relapse triggers, communication, and behavior norms that impede treatment. An online confidential pre-post retrospective survey designed using the Drug Abstinence Self-Efficacy Scale. Results: Descriptive statistics run show Cronbach's alpha of 0.96. A two-tailed paired samples t-test was conducted to examine the Overall Confidence Pre-test and Post-test mean difference. The overall confidence post-test was not statistically significant, but it was clinically significant. Clinical significance evidenced by residents 3-point lower confidence post-intervention. Conclusions: How-to elicit behavior change is unique to every individual. The goal is behavior change to sustain recovery and better communication between clients and peer staff to prevent relapse.
ContributorsKoreny, Danielle M. (Author) / Harrell, Liz (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-26
Description
Background/Purpose: The prevalence of overweight and obesity in the pediatric population is a global epidemic. Rapid weight gain in early childhood exacerbates risk factors for obesity, chronic disease in adulthood, and disqualifies 31% of American youth from serving in the Armed Forces. Although the pediatric dependents weight crisis reflects the national dilemma, there are inconsistencies in provider knowledge, limited access to evidence-based, weight management intervention, and treatment options. This paper will assess provider needs, identify opportunity to improve practice, and process used in weight management in the clinic.
Method: Eight military and four civilian pediatric and family practice providers completed a 16-item needs assessment survey. The survey was distributed via email using an online survey tool, and a printed version was provided to those who had not completed it online. Data was collected over 8 weeks and a descriptive analysis of content was done using the Intellectus software.
Results: Although the response rate was 88.9%, it was lower than anticipated due to COVID-19 related military deployments. Descriptive data were obtained on a variety of provider needs and practices. Results provided valuable information on current attitudes of providers. Providers demonstrated a significant need for a multidisciplinary support team including a dietician and more time dedicated to weight management at office visits. At least 50% of providers have had motivational interviewing training and report that they apply these techniques as part of an intervention in patient’s weight management care.
Implication: Data supports overweight and obesity care practice changes in the clinic. Areas identified by providers included the need for further training and clinic management support including the availability of a pediatric dietician added to the healthcare team.
ContributorsGolding, Sonya S. (Author) / Jacobson, Diana (Thesis advisor) / Arizona State University. College of Nursing & Healthcare Innovation (Contributor)
Created2021-04-27