Digital Commons Network^™

Caring For Fat Bodies: Bridging The Gap Between Intention And Practice In Primary Care, Sadie Pile

Doctor of Nursing Practice Projects

Healthcare providers work hard to support patients in optimizing their health. Typical care prioritizes use of the body mass index (BMI) which has widely been criticized for its ineffectiveness at measuring health, and which perpetuates a white European male body as “normal”. From individual care to public health policy, the measurement of health through BMI and thinness has created and enforced weight stigma. Literature over the past 20 years has continued to demonstrate the negative health impacts of weight stigma, not only in harming physiological, psychological, and behavioral health, but also in fact contributing to weight gain. Notably, the research …

Older Adults In Primary Care With Substance Use Disorders: Assessment Of Self-Perceived Confidence Following Implementation Of A Treatment Toolkit For Providers, Cordelia R. Cochran

Doctor of Nursing Practice Projects

Purpose: The present study had two aims: 1) to increase the self-perceived confidence level of primary care providers in their ability to screen and implement brief interventions with older adults (OAs) with substance use disorders and 2) to understand the primary care providers perception of the provided Screening Brief Intervention and Referral to Treatment (SBIRT) training session/toolkit. Background: OAs are more at risk for SUDs due to varying social factors they experience at their stage of life. Design: The study was a non-experimental one group pretest-posttest design. The participants were primary care providers (N=4). The intervention consisted of an in-person …

The Impact Of Mobile Integrated Healthcare On 911 Use And Patient Activation, Jocelin Olin

Doctor of Nursing Practice Projects

Background: Emergency Medical Services (EMS) and Emergency Departments (EDs) are experiencing an increase in low-acuity and high frequency patients. Treating non-emergent patients with emergency resources drives up healthcare costs, leads to delays in care for all patients, and increases strain on emergency resources. To address the increase in low-acuity and high-frequency patients within the 911 system and emergency departments, mobile integrated healthcare (MIH) has emerged as an EMS-based intervention to connect patients with community resources and reduce non-emergent transports and ED visits. This program evaluation examines the impact of nurse-social worker teams in a fire-based MIH program by measuring 911 …

Covid-19 Vaccine Hesitancy: A Qualitative Study Exploring Factors In Vaccine Decision-Making In Parents Of School-Aged Children, David Misslbeck

Doctor of Nursing Practice Projects

Background: As of May 3, 2023, within Washington state, of those aged 5-11 years old only 36.8% having received one dose of the COVID-19 vaccine, and only 32.3% are fully vaccinated. Since October 2021, the COVID-19 vaccine produced by Pfizer-BioNTech has been approved for everyone ages 5 years and older. Current recommendations encourage parents to vaccinate their children in this age group, but it is possible Washington parents have some reservations or other difficulties with choosing to vaccinate their children against COVID-19. Purpose: The purpose of this study was to explore what factors influence parents of Washington state when …

No Blood Test For Bipolar, No Dura Mater Scan For Depression: Accuracy In Diagnosing Mood Disorders, Duane Patterson

Doctor of Nursing Practice Projects

Misdiagnosis of mental illness is a regular phenomenon that occurs in therapy, nursing, psychiatry, and primary care (McIntyre, 2022; Wolkenstein et al., 2011). Mood disorders are the most common category of mental health disorders, with depression being the leading cause of worldwide disability (WHO, 2017). Mood disorders are misdiagnosed at a very high rate, with 70% of bipolar parents being diagnosed with another disorder, and depression garnering false positive and false negatives by general practitioners at rates of 69% and 65%, respectively (Aznar-Lou, 2019; Fernandez, 2010; Shen et al., 2018). Psychopharmacology is the most common treatment for mood disorders provided …

The Integration Of A Behavioral Health Provider In A University Health Center, Patricia M. Joyce

Doctor of Nursing Practice Projects

Depression and suicidality rates among U.S. college students are rising, along with a surge in urgent mental health needs. Behavioral health care has traditionally been siloed and outside the doors of primary care. Integrating behavioral health services into primary care is an optimal access point for the timely diagnosis of college-age youth to be screened and assessed for mental health care. This program evaluation project sought to measure staff and provider confidence, competence, and satisfaction in treating and managing college student mental health conditions before and after hiring a psychiatric mental health nurse practitioner (PMHNP) in an on-campus university primary …

Utilizing The Butterfly Hug To Reduce Distress In Emergency Department Nurses, Darian Hawke

Doctor of Nursing Practice Projects

Emergency department (ED) nurses are experiencing high levels of job-related distress. However, only some studies have examined ways to mitigate this distress. This project aimed to assess ED nurse distress and to reduce that distress with the Butterfly Hug. ED nurses were taught how to use the Butterfly Hug, a low-intensity, self-administered eye movement desensitization and reprocessing (EMDR) based bilateral stimulation technique to reduce distress. The Need for Recovery (NFR) Scale was used to assess their distress level pre- and post-test. Seven participants completed this project. One month after being taught to ED nurses, the results show that participants who …

Trauma-Informed Care Training In The Women’S Healthcare Setting, Aimee D’Avignon

Doctor of Nursing Practice Projects

Purpose: This project is designed to improve knowledge and use of trauma-informed care in the midwifery setting.

Background: Research has shown that medical procedures and treatments can be distressing and trigger post-traumatic stress disorder symptoms in those with trauma histories. Obstetric and gynecological evaluations and procedures are intimate and invasive, putting the patient in a vulnerable situation. Midwifery facilities are in a unique position to provide support through trauma-informed care. However, despite evidence showing the benefit of trauma-informed care provision, training and implementation in the women’s healthcare setting are limited.

Design: A validated pre- and post-survey was utilized to assess …

Needs Assessment To Improve Sepsis Bundle Compliance In The Emergency Department, Jenesa Chin, Rae Maierhofer

Doctor of Nursing Practice Projects

Sepsis is a leading cause of morbidity and mortality worldwide. Treatment depends on time-sensitive antibiotic initiation, fluid resuscitation, and vasoactive support. Early recognition and bundled care are core tenets of management. Thus, this project aims to identify barriers to sepsis bundle compliance in a local community emergency department. Specifically, how do perceived barriers to sepsis bundle compliance as identified by staff correspond with quantitative delays in care as demonstrated by chart data? This mixed-methods needs assessment consists of staff surveys and analysis of extracted chart data. Staff surveys revealed barriers including staffing shortages, difficulty with intravenous (IV) access, and lack …

Reducing Coercive Measures To Improve Patient And Staff Safety By Increasing The Frequency Of Risk Assessment, Fonabei Ayongaba, Ethan Raether

Doctor of Nursing Practice Projects

Violence is a critical issue in Healthcare. Inpatient psychiatric nurses are the healthcare professionals most affected by this problem. Structured risk assessment tools can predict imminent aggression, prompt interventions, mitigate the advent of aggressive behaviors and staff and patient injuries, and reduce restrictive aggression management methods. This quasi-mixed methods project instructed registered nurses in an acute inpatient psychiatric unit to implement the Dynamic Appraisal of Situational Aggression (DASA: IV) more frequently to determine the impact on aggressive behaviors, the use of coercive techniques to manage aggression, and to assess nurses' perception of the tool. Twenty-five registered nurses screened 447 patients …

Improving The Delivery Of Preconception Counseling In Primary Care Settings: A Student-Focused, Isla Oliver

Doctor of Nursing Practice Projects

Preconception counseling (PCC) is identified by United States (U.S.) public health and professional organizations as an important aspect of primary care for people of reproductive age. The majority of pregnant women in the U.S. report never receiving PCC, and studies show that physicians and Nurse Practitioners feel inadequately prepared to offer the service. In this evaluation of a digital preconception counseling toolkit for students in a Doctor of Nursing Practice program, students’ discrete knowledge of PCC concepts improved after implementation. Student training within Nurse Practitioner programs may increase comfort with and provision of this service to their patients after graduation.

Barriers To Attending Vaginal Breech Birth In The American Healthcare System: A Qualitative Analysis, Hilary Schumer

Doctor of Nursing Practice Projects

A fetus is considered breech when the presenting part is the buttocks, foot/feet, or hips. Annually, approximately 5% of all pregnancies in the United States (U.S.) are breech at term (Centers for Disease Control and Prevention, 2021). Vaginal delivery of a breech baby is increasingly rare in the U.S., as 95% of those presenting as breech at term are delivered via cesarean section (Centers for Disease Control and Prevention, 2021). While the number of vaginal breech deliveries has been trending downwards since the 1970s, the rate dropped precipitously in 2000 after the Term Breech Trial (ACOG, 2020; Freeze, 2019; Hunter, …

Ketamine Assisted Psychotherapy For Mental Health Conditions, Michelle Julseth, Andrea Schneider

Doctor of Nursing Practice Projects

Mental health conditions including depression, anxiety, and post-traumatic stress disorder impact the lives of almost a billion people worldwide. The current standard pharmacological interventions offer limited benefits, but new research in ketamine-assisted psychotherapy (KAP) has shown promising outcomes. This study sought to add to the existing body of research regarding KAP by measuring whether depression, anxiety, and/or spirituality scores improved significantly in participants after one KAP session by measuring Patient Health Questionnaire-9 (PHQ~9) scores, General Anxiety Disqrder-7 {GAD-7), and National Institute of Health Healing Experience of All Life Stressors (NIHtHEALS) scores, respectively. A retrospective chart review performed on clinical data …

Enhancing Diversity In The Nursing Workforce: An Evaluation Of Multicare’S Nurse Pipeline Program, Mckenzie Golden

Doctor of Nursing Practice Projects

Associations exist between poor racial/ethnic representation in the healthcare workforce and lower quality of care, increased disability and mortality in communities of color (Jones et al., 2021; The Sullivan Commission 2004). Research supports that pipeline programs introducing underrepresented students to careers in nursing and allied health are effective at increasing diversity in nursing, student self-efficacy and influence them toward such careers in healthcare (Butler & Ampadu, 2020; Crews et al., 2020; Mei et al., 2022). This study is a program evaluation utilizing a descriptive mixed methods survey to assess the influence of Multicare’s nurse camp on alumni from the 2016-2020 …

Educating Primary Care Providers To Include Community Health Care Workers Within A Healthcare System, Bobbi Beard

Doctor of Nursing Practice Projects

Background: Evidence shows community health workers (CHWs) can effectively deliver proven behavior change strategies to prevent chronic disease (CD) and enhance preventive care efforts in primary care. However, CHWs are still an unfamiliar term in healthcare and remain underutilized.

Objective: To determine whether providing education regarding the role of the CHW to PCPs can increase the use of CHWs within a health care clinic.

Setting: Primary Care Providers (PCPs) at an ambulatory primary care clinic in Washington State that is part of a research and learning/teaching (Academic) hospital and healthcare system.

Design: Guided by Wiedenbach’s Prescriptive Theory, this study features …

Mindfulness For Inpatient Psychiatric Clinical Staff: Designing And Evaluating A Pilot Intervention To Reduce Stress And Burnout, Daniel Brusser

Doctor of Nursing Practice Projects

Background: The COVID-19 pandemic has both highlighted and compounded a burnout crisis among the healthcare workforce. Healthcare professionals are experiencing workplace stress and professional burnout in substantial numbers, which has resulted in multiple negative consequences including decreased productivity, poor staff retention, and increased organizational costs. While effective multi-pronged approaches to address stress and burnout among healthcare professionals account for the problem at all levels from individual to organizational, a growing evidence base supports the implementation of mindfulness-based interventions as one strategy to reduce stress and burnout and build resiliency.

Objectives: The purpose of this DNP project was to design …

Implementation Of A Patient Satisfaction Survey: A Pilot Project, Amy Brenner

Doctor of Nursing Practice Projects

Background: Patients who report higher satisfaction scores have better healthcare outcomes and lower financial burden in comparison to those who report lower satisfaction scores. Those less satisfied with their medical care tend to have poorer physical and mental health, which can impact daily life. For students in particular, health status impacts academic performance. Patient satisfaction surveys are a standard tool used to determine areas needing improvement within a healthcare delivery system.

Objective: The purpose of this project was to implement a patient satisfaction survey at a student health center on a university campus.

Design: The project was a two-month pilot …

Exploring Current Practices Of Pediatric Providers Serving Transgender/Gender Non- Conforming (Tgnc) Youth 12 Years Of Age And Under In The Washington, Alaska, Montana, Idaho Region, Perry Loiselle, Luke Van De Krol

Doctor of Nursing Practice Projects

Transgender and gender non-conforming (TGNC) youth 12 years of age and under, often present first to their pediatric primary care providers for needs related to their gender identity. Primary care providers are uniquely positioned to address needs for these individuals and their families. Many primary care providers have no additional training for this special population, especially for pre-pubescent TGNC patients, and have varied levels of comfort and strategies regarding signaling acceptance, screening and assessing practices, referral practices, and discussing gender and physical characteristics topics. This project explores current practices of primary care providers in the Washington, Alaska, Montana, Idaho (WAMI) …

An Evaluation Of A Palliative Care Consult Screening Tool For The Intensive Care Unit: A Quality Improvement Project, Justin Yoshimoto

Doctor of Nursing Practice Projects

Patients in the intensive care unit (ICU) are at risk for unmet palliative needs. A palliative care consult screening tool, designed by the Center to Advance Palliative Care (CAPC), was trialed in a 6-week retrospective chart review of patients admitted to a 30-bed ICU in Washington State. for a 6-week period in 2021. The screening tool included a collection of 8 unit-specific criteria, where if a patient met any of the criteria, that patient was flagged for a potential palliative care consult. The aim of this project was to evaluate the screening tool for its ability to identify and triage …

Expanding Suicidality Triage To Primary Care Nurses: Improving Confidence And Knowledge, Gabrielle Geiger

Doctor of Nursing Practice Projects

Suicide is a growing public health crisis and there is an increasing need for skilled medical professionals educated to triage patients experiencing suicidality. Most of the training available for triage and resource utilization is offered to professionals already working in a behavioral health discipline. Given the increasing prevalence of suicide and depression, individuals experiencing mental health crises face reduced access to specialized care, complicated referral processes, and exceedingly long waitlists. In response, they are seen with increasing frequency in primary care settings where nurses are not as prepared to manage their needs appropriately. The aim of this project was to …

Nursing Care For Transgender And Nonbinary Patients An Educational Model For Forensic Nurse Examiners, Shoshana Dickerson

Doctor of Nursing Practice Projects

One of the greatest barriers to healthcare faced by the transgender and nonbinary (TGNB) population is the lack of access to providers who are knowledgeable in providing safe, appropriate, and gender-affirming care. LGBT education for most nursing baccalaureate nursing programs contains only 2.12 hours of LGBT-related content in their curricula, with even less time specifically devoted to transgender health topics. One foundational intervention for addressing healthcare disparities among the TGNB population is to provide better and more inclusive education for nurses about gender-affirming care. The purpose of this quality improvement project was to design, implement, and evaluate an interactive educational …

Adult Depression Screening In Primary Care, Jeremy Bang

Doctor of Nursing Practice Projects

Routine depression screening of adults in primary care is recommended by many US professional organizations. This quality improvement project found a low baseline rate of screening at a primary care clinic and attempted to increase the rate by creating a revised depression screening workflow. The workflow was created based on staff recommendations gathered through Appreciative Inquiry-grounded interviews. Its efficacy was evaluated by comparing depression screening rates before and after its implementation, and staff evaluated outcomes with anonymous surveys. Overall depression screening rates at the clinic increased from 20.83% to 29.14% (p < .001) in response to the project’s interventions. Continued improvement of the depression screening process at the clinic and other clinics in the parent organization calls for soliciting further staff suggestions and expanding evaluation measures.

Optimizing Food Access In The Enhanced Shelter Environment: A Policy Evaluation Project, Reanna Moore

Doctor of Nursing Practice Projects

In the unhoused population, food access is a basic human need important not only for adequate nutrition, but also reducing feelings of food insecurity. Enhanced shelters are well poised to impact food access by providing meals and storage options for shelter residents. However, food hoarding behaviors, food safety concerns, and limited budget add complication to this problem. Shelter policies that optimize the availability of meals, food storage, and kitchen use have the potential to positively impact food security, but must be balanced with the individual needs of the shelter. It is important for enhanced shelters to identify best practices and …

Best Practices For Health Equity And Antiracism Curriculum For Healthcare Workers Regarding Sb 5229, Amanda Osei, Iman Yunis

Doctor of Nursing Practice Projects

Interpersonal racism, bias, and discrimination can often directly contribute to poor healthcare outcomes. Their correlation can be seen in infant mortality, maternal mortality, life expectancy, heart disease, cancer, and more (Bailey et al., 2017; Gee & Ford, 2011). The COVID-19 health pandemic reinforces this pattern of health inequity. Structural inequalities during the pandemic further emphasized racial and ethnic disparities in BIPOC populations. BIPOC populations are more likely to have conditions associated with increased risk of illness from COVID-19 relative to their white counterparts (Raifman et al., 2020). Barriers to achieving health equity include lack of policy addressing health inequities and …

Improving Access To Appropriate Level Of Psychiatric Care For Youth In Washington State, Natasha Zamora

Doctor of Nursing Practice Projects

Objective: To advocate for better mental health coverage for adolescent youth, the goal of this DNP project was to identify disparities across levels of care based on insurance type to propose a solution that improves accessibility to appropriate levels of care for all adolescents.

Design: This is a patient advocacy project that utilized a retrospective chart review.

Setting: The setting for this project was a 27-bed hospital-based adolescent behavioral health unit in a hospital in Tacoma, WA.

Participants: Participants included 875 patients admitted to the unit between April 2020 and April 2021. Methods: Patient charts from the desired time frame …

Improving Continuity Of Mental Health Care For Women: Jail Release To Community Re-Entry, Janin Khaleel

Doctor of Nursing Practice Projects

Introduction: This formative Delphi study assesses 1) potential policy changes most needed to support mental health care continuity for women being released from two urban jails, 2) barriers to women obtaining mental health services after release, and 3) understanding what community resources are promoting continuity of mental health care after jail release.

Methodology: This is a policy project that uses the Delphi method. In phase one, a primarily qualitative survey was administered to jail health experts to explore project aims. Results were analyzed with thematic analysis, and themes were used to develop a primarily quantitative second survey with Likert scale …

Building Resources For Transgender And Non-Binary Youth: A Sexual Health Toolkit, Emma Lieuwen

Doctor of Nursing Practice Projects

Background: Transgender and nonbinary (TGNB) youth make up almost two percent of the student population in the United States (Johns et al., 2019). They face usual challenges of adolescence, including identity, relationships with parents and peers, and body image, but also must navigate stigma, discrimination, and difficulties accessing necessary resources and information (Tankersley et al., 2021). Particularly, the sex education TGNB youth receive is often inadequate in relevant content for navigating puberty, sex, and relationships (Haley et al., 2019; Pampati et al., 2020). Youth may be left feeling ill-prepared for intimacy, puberty, or coming out, and be more likely to …

A Formative Evaluation Using Re‐Aim Framework For Enhanced Shelter Services, Raissa Meegan

Doctor of Nursing Practice Projects

Background: Poor health is not only a major cause of homelessness but being homeless also worsens existing health issues. Effective interventions that address the unique needs of this population are a critical component of ending homelessness. A review of literature has revealed four evidence-based approaches that includes a Housing First approach, Trauma Informed Care (TIC), case management, and service integration as key priorities for homeless service providers. It is important for service organizations supporting this population to conduct program evaluations to ensure best practices are utilized in program implementation.

Objectives: The objective was to perform a formative evaluation guided by …

Group-Based Diabetes Self-Management Education For Somali Population With Type Ii Diabetes Mellitus, Hamdi Abdi

Doctor of Nursing Practice Projects

Background and Purpose: Type II Diabetes Mellitus (T2DM) is a serious chronic disease that requires knowledge, daily self-management, and lifestyle modifications. T2DM is a widespread disease in Western world, however, it affects racial minority immigrant populations, including Somalis at disproportionally higher rates than the general population. This quality improvement project was developed and piloted to discern whether culturally appropriate small group-based education program for Somali patients with T2DM may improve self-management skills to alleviate long-term complications.

Methods: This project used descriptive statistics to compare participants’ knowledge and T2DM self-management behavior pre and post intervention. Subsequent to Seattle University IRB approval, …

Be-Fast Assessments In Emergency Departments To Increase Recognition Of Posterior Circulation Strokes, Hannah Kramer, Alvina Wong

Doctor of Nursing Practice Projects

Posterior circulation strokes are often missed in emergency departments due to atypical symptom presentation that leads to poor prognosis and increased medical costs related to treatment. The purpose of this project is to increase identification of posterior circulation strokes by providing an educational tool and introducing a revised stroke assessment tool that includes symptoms caused by posterior circulation strokes. Success of project implementation was measured by improved test scores of post education and post intervention questionnaires, increased use of the BE-FAST assessment tool, increased completed MRIs, and an increase in the number of confirmed posterior circulation strokes. This multi-part quality …