Digital Commons Network^™

Education And Implementation Of Polst Protocols In Northern Arizona, Dawn M. Rivas

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Provider orders for life-sustaining treatment (POLST) is a medical order set that is signed by a physician, nurse practitioner, or a physician assistant and describes how patients wish to be cared for regarding their medical treatment (or refusal of) during times of serious illness and frailty. POLST provides continuity of care across settings of care, increased quality of life and, improved patient satisfaction. POLST is not readily available in all of the United States, and Flagstaff currently has the only POLST program in the state of Arizona. The purpose of this multi-step doctor of nursing practice (DNP) project was to …

Depression Screening To Improve Early Detection, Referral, And Treatment Of Depression In Patients With Diabetes, Karina Avechuco

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Comorbid depression is common among adults with diabetes and is associated with negative impacts on quality of life, health outcomes, and mortality rates. As of 2015, it was estimated that 415 million people were living with diabetes in the United States, and of those affected, 20 to 25 percent have some degree of depression. Evidence-based guidelines recommend routine depression screening. This appears to decrease negative health outcomes and may be a cost-effective way to reduce the risk of adverse outcomes. Despite recommendations, depression screening in patients with diabetes is not consistent. This is true for patients at the study clinic …

Addressing Compassion Fatigue Of A Family Caregiver Of Adolescents In A Mental Health Setting: A Practice Change Project, Suzanne Mcwilliams

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Family members who care for adolescents with a mental health disorder (AMHD) have yet to be recognized as an at-risk population for developing Compassion Fatigue (CF). The project introduced the concept of CF and the development of a program for family caregivers of AMHD at New Haven, a residential treatment center (RTC) for adolescent girls with mental health disorders. Staff therapists, nurses, educators, and support staff attended an educational program on CF, validated screening tools, interventions, and educational materials for family caregivers. A pre/post-Continuing Professional Development Reaction Questionnaire (CPDRQ) was used to measure their intention to change practice. Family caregivers …

Implementing Recommended Perioperative Pain Practice Guidelines By Incorporating Intravenous Acetaminophen, Sarah Ann Torabi

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Optimizing perioperative pain management is important in decreasing adverse outcomes in surgical patients. The purpose of this project was to implement recommended perioperative pain practice guidelines by incorporating intravenous acetaminophen (IVA) as part of multimodal analgesia at an acute care hospital in Northern Arizona. Lewin's change theory guided this project by using strategies to break barriers in accepting and changing perioperative pain guidelines by completing a retrospective chart review to determine IVA efficacy. Data was obtained from adult surgical patients at this facility from January 1, 2014-July 31, 2014 which resulted in 74 charts that met criteria; 37 patients received …

Implementing Evidence To Improve Chronic Insomnia Treatment For Older Adults In Primary Care: A Quality Improvement Project, Mariama Bayoh

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Background: Chronic insomnia (CI) affects over 50% of American adults 65 years and older. The most currently used treatment approach for this problem is inconsistent with the most up-to-date evidence-based clinical guidelines and research. Despite the apparent benefits of cognitive-behavioral therapy for insomnia (CBTI) as an effective tool for the treatment of CI in adults, pharmacologic treatment remains the standard care for CI in the primary care setting. This health care improvement project aimed to improve the application of evidence for CI treatment by increasing the clinic providers' awareness of CBTI as first-line treatment for CI.

Methods: The Plan Do …

Chronic Pain: Relationship To Depression, Eugenia Ursan

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

The experience of chronic pain often interferes with family and social life, work performance, and overall quality of life. Depression symptoms in people with chronic pain may synergistically effect pain perception, negatively influencing the response to pain management and rehabilitation. Providers often fail to recognize and treat depression in patients presenting for treatment of chronic pain, and this failure can negatively impact rehabilitation outcomes. Importantly, limited research exists within the physical medicine setting about the relationship between chronic pain, symptoms of depression, and other variables like age and gender. Therefore, the relationship between chronic pain and depression in patients …

A Screening Tool For Early Recognition And Treatment Of Sepsis, Diane M. Moss

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Purpose: This study investigates the use of a sepsis screening tool to decrease the length of time from triage to treatment.

Design: In this exploratory study, a convenience sample was drawn from all patients triaged in a critical access hospital emergency department in a six-month period from April 1 through September 30, 2012 and April 1 through September 30, 2013 with a total number of patients of 10,143 for both years. Each patient who was triaged in 2013 was screened for sepsis using the sepsis screening tool and then suspected and positive screens were compared to patients in 2012 that …

Nurse Preceptor Support, Heidi Kosanke

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Competence and clinical judgment among new graduate nurses are at a historical low of 9% based on observational performance assessments (Kavanagh & Sharpnack, 2021). This points to a need for collaboration between academia and practice to improve the practice readiness of senior nursing students prior to their transition to practice. The nurse preceptor is well-recognized as a key to success for both senior nursing students and new graduate nurses. Support and training for nurse preceptors are essential aspects of improving practice readiness in novice nurses. A recent review of standard preceptor training and nurse preceptor perception of practice readiness indicates …

Qualitative Assessment Of An Electronic Diabetes Education Tool For Burmese Immigrants, Jillane Ocano

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Providing preventative health education to refugee groups presents challenges due to language barriers, limited literacy, educational resources, and time constraints. Purpose: pilot an electronic audio-visual Burmese language diabetes educational tool (BDET) designed for low literacy Burmese speaking patients. Sample and setting: eleven adult Burmese speaking patients at a family practice clinic. Methods and measures: qualitative descriptive design utilizing a semi-structured 10 item survey, delivered via interpreter to obtain participant perceptions and opinions of BDET. Findings: BDET provided novel diabetes information in an acceptable format. Participants perceive diabetes to be a very serious disease, however, perceived personal risk of diabetes and …

Palliative Care: Improving Eligible Patient Identification To Encourage Early Intervention, Norma H. Clark

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Palliative care (PC) encompasses a holistic way of caring for patients and families with chronic disease or life-limiting illness through optimal symptom management. Individuals in need of PC has reached 20 million annually world-wide. Many patients in need of this service never receive a consultation, or if they do, it comes late in the disease process. Some health care specialists see PC as incongruent with treatment, while others have a lack of understanding of what this service provides. Additionally, many providers have few or no resources to guide in the recognition of PC needs. This practice improvement project emphasized identification …

Evidence Based Change: A Protocol To Reduce Ambulance Diversion Using The National Emergency Department Overcrowding Scale Tool, Kathryn S. Rogers

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Background: Ambulance diversion (AD) occurs when emergency departments (EDs) experience over-demand of available resources and can no longer accept ambulance patients. Current evidence however, shows that AD delays critical care, negatively impacting quality and cost. The purpose of this project was to reduce AD by creating an evidence-based protocol in the ED setting. Methods: Underpinned by Kurt Lewin's Change Theory and following a Plan Do Check Act model, a healthcare quality improvement team implemented an AD protocol in a busy urban ED. Baseline data was taken from historical hours of AD use and ambulance arrivals over the previous three years. …

Influenza Education To Improve Vaccination Rates Among College Students, Shelley Vaughn

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Objective: The purpose of this project was to provide influenza vaccine education and improve vaccine uptake among Eastern Arizona College dormitory residents. College students living in dormitories are considered a high-risk population for influenza, and the current vaccination rate for this age group is reported as 41.1% nationally, compared to Healthy People 2020’s goal for influenza vaccination of 80%.

Participants: The population comprised 300 Eastern Arizona College dormitory residents aged 18 and older.

Methods: During back-to-school week, students participated in an influenza education intervention. At 4 weeks post-intervention, a 10-item follow-up survey was administered electronically to measure the impact of …

Identification Of Internal Risk Factors And Interventions To Prevent Exertional Heat Illnesses In Hikers: A Systematic Review, Sheri D. Erwin

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Objective: To identify internal risk factors (e.g., caffeine and alcohol consumption, weight, medications, and medical conditions) and intervention strategies for prevention of exertional heat-related illnesses in hikers.

Methods: A systematic review was conducted using a predetermined list of MeSH headings to identify articles on exertional heat-related illnesses. CINHAL, MEDLINE, and PubMed databases were searched for articles published between 2009 and 2014. The studies were ranked using the Oxford Centre for Evidence-Based Medicine classification system. Studies were included if they had a level of evidence of 3 or higher or a grade of C or better.

Results: The initial search resulted …

Implementation Of A Diabetes Treatment Algorithm In Primary Care For Use In The Adult Hispanic Population, Heidi Marshall Dillenbeck

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Diabetes Mellitus Type 2 (DM2) is a growing problem in the United States. Hispanic Americans have a higher prevalence of diabetes than Non-Hispanic Whites and suffer from more severe complications of the disease. Although advances in diabetes treatment over the last decade has improved, management of diabetes in primary care is inconsistent despite well-publicized guidelines from the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). With the growth of the Hispanic population expected to reach 25 % of the U.S. population by 2050, practice changes must be made to improve diabetes management. The literature supports the …

Faculty Development To Support Interprofessional Education In Healthcare Professions: A Realist Synthesis, Katherine Dolan Watkins

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Interprofessional education (IPE) is essential to graduate collaboration-ready healthcare professionals. Faculty have limited experience and expertise in facilitating IPE, slowing adoption of this strategy. This article informs the dialogue about faculty development for IPE in academic settings. Through a realist synthesis, the key mechanisms that underpin IPE faculty development and the contextual influences are explained.

Improving Culturally Competent Care For International Students, Jean Penrose Arlotti

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Background: As the international student population grows on college campuses across the United States (U.S.), health professionals are challenged to meet national and college health objectives for providing culturally competent care. International students often have unique cultural needs, have lower health literacy, and face language barriers when accessing health care in the U.S. The aim of this Doctor of Nursing Practice (DNP) project was to implement and evaluate an evidence-based practice change directed at addressing a gap in health care for Chinese international students.

Methods: This DNP quality improvement project introduced translated patient education materials from an online resource for …

Improving Intimate Partner Violence Screening In The Emergency Department Setting, Laura M. Karnitschnig

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Intimate partner violence (IPV) is a significant public health issue. Global rates of IPV range between 15% and 71%. Approximately three million U.S. women are affected during their lifetimes; and approximately 15.5 million children in the U.S. are exposed to violence in the home annually. To provide resources and decrease health consequences of exposure to violence, violence screening in healthcare settings has been recommended by both medical and nursing organizations. The objectives of this study were to improve RNs' ability to screen for IPV, increase identification of individuals and families exposed to IPV and ensure provision of appropriate resources, and …

Program Evaluation: Implementing Trauma-Informed Care Via The Sanctuary Model, Michele Bronder

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

The inpatient psychiatry unit at Phoenix Children's Hospital is implementing trauma-informed care via the Sanctuary Model to provide trauma-responsive care to the patients served. Initial training on the Sanctuary Model was provided to unit employees in 2021 as the new model of care. A decrease in the use of restraints and seclusions and an increase in employee retention rates since initial training indicate the positive effects following a trauma-informed care model can have on both patients and employees. However, there continues to be resistance to full model utilization and underlying incivility since initial training. This Doctor of Nursing Practice (DNP) …

Implementing A Community Education Campaign To Improve Prenatal Care Among Navajo Women, Adrien J. Gupton

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Early and consistent prenatal care (PNC) is essential to preventing adverse maternal and neonatal outcomes. Despite the recommendations made by the World Health Organization and the American College of Obstetricians and Gynecologists, childbearing women with health disparities living in rural settings are at an increased risk of experiencing inadequate PNC compared to their urban counterparts. The literature search suggests that limited access to PNC, childcare during the PNC visit, health care provider's perceptions of patients, and provider mistrust are barriers to early and consistent PNC. Growing research is placing a call to health care providers to implement interventions that are …

Implementation Of Rheumatoid Arthritis Assessment Tool: A Quality Improvement Project, Christina Mooroian-Pennington, Dorothy J. Dunn

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Objective. Rheumatoid arthritis is a common inflammatory arthritis resulting in joint destruction that leads to physical and functional disability. This condition is characterized by variable disease activity levels, defined as low, moderate, and high. The higher the disease activity the more at risk the patient is for joint joint destruction. The routine use of an approved composite index for disease activity is recommended to assess disease activity level at each office visit. The American College of Rheumatology approved six composite indices; the Patient Activity Scale (PAS), the Patient Activity Scale II (PAS-II), the Routine Assessment of Patient Index Data 3 …

Impact Of Equine Programs To Treat Autism On Caregiver Stress, Jennifer May

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

When a child is diagnosed with autism spectrum disorder (ASD), caregivers must navigate a complicated maze of information while experiencing their own emotional journey. Maladaptive behaviors seen in children with ASD can make daily routine tasks difficult to complete and attribute to higher levels of caregiver stress. Complementary and alternative medicine (CAM) approaches in treating ASD are gaining interest as caregivers are becoming involved in care planning. Equine programs are becoming increasingly popular options to treat maladaptive behaviors associated with ASD. The purpose of this project was to evaluate if equine programs in the Phoenix, Arizona area used to treat …

Recommendations For Promoting Culturally And Resource Appropriate Care For Native American (Na) Patients At Flagstaff Medical Center (Fmc), Aura Leaf Kaila Edmondson

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Flagstaff Medical Center (FMC) is a primary referral center for its surrounding Native American (NA) communities. As such, FMC has a unique patient population with distinctive needs related to culture and available resources. This executive summary explores the provision of quality care to NA populations by discussing the execution of a clinician focused education needs assessment, implementation of an education program based upon this data, and synthesis of the experience to provide institutional recommendations for ongoing efforts to optimize the care of NA patients from a cultural and resource perspective.

Compassion Fatigue: A Leadership Driven Quality Improvement Project, Peggy Bradley

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Compassion fatigue, defined as the physical and mental exhaustion experienced by those who care for sick or traumatized people over an extended time-period (Merriam-Webster, 2019; Berg, et. al., 2016), has emerged as a leading concern for healthcare professionals and organizations locally, nationally, and globally. It negatively impacts personal and professional relationships, physical and mental health, personal and professional performance, as well as standards of patient care. Approximately 16% to 85% of the healthcare workforce suffers from compassion fatigue, putting them at increased risk for poor personal and professional judgment, reduced job satisfaction, increased turnover, and costs the economy billions of …

Evidence-Based Practice Change: Implementation Of A Collaborative Practice Model For Diabetes, Emma L. Edwards

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Background: The prevalence of type II diabetes mellitus (T2DM) in the United States is high, especially in underserved populations. Many patients with T2DM do not receive the optimal interprofessional collaborative care that has been shown to improve outcomes. A model of care that incorporates these evidence-based recommendations is integral to improving the quality of diabetes care. A growing body of literature identifies the use of a provider-clinical pharmacist collaborative practice (P-CPCP) model of care as an effective, innovative, and evidence-based practice that will improve patient outcomes.

Purpose: In response to an identified need to improve T2DM patient care in an …

Enhancing Patient Education To Reduce Unnecessary Health Information Seeking Behavior After Cardiac Ablation, Carla Lockhart

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Problem: Atria fibrillation (a-fib) is an irregular heart rhythm effecting approximately 2.7 to 6.1 million individuals annually (CDC, 2017), of which approximately 153 underwent catheter ablation by the electrophysiologist during 2018. Patients commonly experience concerns in the three months following surgery known as the "blanking period." Repeated unnecessary patient behaviors inclusive of phone calls, emails, consultations, and emergency visits are a common concern to healthcare providers.

Method: This project developed an enhanced educational tool and used a chart review of N=16 to measure health-seeking behaviors before and after exposure to the enhanced education tool. Frequencies were calculated and a chi-square …

Behavioral Health Integration In Primary Care: A Quality Improvement Project, Sarah Claussen

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

This quality improvement project aimed to identify and treat patients at risk for depression and anxiety, facilitating earlier entry into treatment through increased screenings during routine primary care visits. Utilizing screening tools such as PHQ-9, GAD-7, and C-SSRS ensured comprehensive mental health assessments. Implementation of the Collaborative Care Model at Priority Family Medical Clinic improved patient outcomes, satisfaction, and reduced healthcare costs, addressing disparities in access to behavioral health services. The project enhanced identification and management of depression and anxiety, leading to increased referrals to CoCM, psychiatric services, and medication initiation, highlighting the effectiveness of integrating mental health screenings for …

Implementation Of Depression Screening To Optimize Chronic Pain Management, Aaron B. Castle

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Background: Chronic pain affects millions of people worldwide and the evidence demonstrates prevalent co morbidity of chronic pain and psychological issues such as anxiety, insomnia, and depression. The existence of psychological issues can have negative impact on pain management and compound the challenges inherent to successful management. Although clinical Practice Guidelines (CPG) recommend routine screening for depression, anxiety, and insomnia in all chronic pain patients, many primary care providers fail to routinely perform appropriate screening. The purpose of this project was to implement a practice change that would include screening for depression with chronic pain patients in a rural …

Behavioral Health Self-Help Interventions Conducted During Chronic Pain Visits In A Primary Care Setting, Bessie Burk

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Purpose: This practice implementation assessed the feasibility and impact of implementing behavioral health self-help interventions during chronic pain management visits in a primary care setting.

Data sources: Time series data collection occurred following the implementation of behavioral health interventions utilizing self-help strategies that included the Gate Control theory of pain control and sleep hygiene. Participants received monthly pain management visits conducted by their usual provider and interventions were performed by a single behavioral health specialist for consistency.

Conclusions: Mean pain scores were significantly reduced from 5.93 to 4.29 (p=0.000) on a scale of zero to ten, and improvement was …

Development Of A New Practice Model: Postmortem Sexual Evidence Collection Forensic Examiner Multimedia Training Module, Kirsten O. Turkington

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

The aim of this Forensic Nurse Examiner (FNE) practice improvement initiative was to design an online multimedia training module for postmortem sexual evidence collection. FNEs, as clinical experts in antemortem sexual assault and interpersonal violence evidence collection, are uniquely qualified for the expanded role in postmortem sexual evidence collection. Current forensic literature lacks data regarding injury identification in sexual homicide victims limiting forensic training, new program development and potential advancements in forensic research. Additionally, inconsistent data collection in sexual homicides poses prosecution concerns with identification of sexual homicides and evidentiary examinations. Antemortem and postmortem sexual evidence collections are not identical …

Diabetes: What Are The Barriers To Diet, Exercise And Medication Adherence In A Rural Southern Arizona Clinic?, Ambur Lindstrom-Mette

Group: Northern Arizona University School of Nursing, DNP Doctoral Papers

Purpose: To identify patient reported barriers to diet, exercise and medication adherence in adults who are diabetic patients in a rural Southern Arizona family practice clinic.

Data Sources: A cross-sectional, quantitative self-reported survey was conducted. The Environmental Barrier Assessment Scale was the used to collect data at routine office visits.

Conclusions: Patients consistently identified problems with health as a barrier to diet, exercise and medication adherence in diabetes. Further discussion with patients is warranted to assist patients and providers to understand what problems are occurring and what the solution may be to help overcome these barriers.

Implications for Practice: Identification …