Medicine and Health Sciences Commons^™

Evaluating The Impact Of Federal Mental Health Policy: An Analysis Of How Federal Deinstitutionalization Impacted Persons With Severe Mental Illness, Jillian K. Douglas

Doctor of Nursing Practice Projects

This policy evaluation project evaluated how federal mental health policy changes impact individuals diagnosed with severe mental illness through analyzing how institutionalization and deinstitutionalization policies impact persons with severe mental illness (SMI). In order to determine how federal policy changes impact outcomes for people diagnosed with SMI, psychiatric hospitalization rates per 100,000 from 1850 to 2015 are compared to the life expectancy, incarceration rates per 100,000, and percentage of unhoused population with SMIs in the United States (U.S.) during the same years. Research compiled for this paper found that decreasing the numbers of psychiatric beds correlates within creased rates of …

Nurse And Family Perceptions Of Family-Centered Care In Phase I Recovery, Anjanette Allard

Doctor of Nursing Practice Projects

Background: Including family in the pediatric post-operative post-anesthesia care unit (Phase I PACU) benefits children and families. Seattle Children’s Hospital’s (SCH) Bellevue campus PACU routinely involves families in Phase I but, despite the same mission that includes family-centered care, the Seattle PACU does not consistently involve families in Phase I. The purpose of this quality improvement project was to analyze nurse and family perceptions of Phase I and to propose a practice change that promotes family-centered care in the Seattle Phase I PACU.

Methods: A survey (11 to 31 multiple choice, Likert style and open-ended response questions) was offered to …

Building Resilience: Piloting A Mindful Self-Compassion And Stress-Management Program For Youth, John A. Hinrichs

Doctor of Nursing Practice Projects

Anxiety disorders, representing the most prevalent classification of mental health disorders across the world, pose a significant public health problem associated with burdensome costs (Baxter, Vos, Scott, Ferrari, & Whiteford, 2014; Greenberg et al., 1999). Although understanding about the etiology and effective treatments for anxiety disorders has grown, general preventative measures are not well-understood or implemented but are needed to reduce the disability and morbidity associated with this debilitating class of disorders. Research has identified perfectionism and self-criticism as risk factors for the development of anxiety disorders and mindful self-compassion (MSC) as a promising intervention to alleviate anxiety disorders (Dunkley, …

Human Trafficking Education Module For Healthcare Providers: Reviewed And Informed By Survivors Of Sex Trafficking, Katlyn Sargent Sheets

Doctor of Nursing Practice Projects

Human trafficking (HT) is an epidemic within the United States, resulting in what could be deemed a public health crisis. HT remains concealed due to the criminal, secretive nature of the enterprise, in addition to inconsistent definitions, historically perpetuated biases, and stigmas, in addition to an overall lack of education, knowledge, and awareness. Data around HT are also minimal due to these same barriers. The majority of HT victims report accessing the emergency department and hospital during their time of trafficking, placing healthcare professionals in a unique position to recognize and assist victims. Studies indicate that few healthcare professionals have …

Depressive Disorders And Substance Abuse Screening In Pediatric Primary Care Using Phq-A And Crafft Screening Tools, Lemuel M. Gitari

Doctor of Nursing Practice Projects

No abstract provided.

Implementation Of Palliative Care For Interprofessional Dialysis Team: Advance Care Planning Communication Training, Ju Choe

Doctor of Nursing Practice Projects

Palliative care (PC) has become the need of the dialysis population to expedite emotional support, symptom management, and decision-making related to end-of-life situations (Sturgill & Bear, 2019). Under the spectrum of PC, advance care planning (ACP) is essential. The benefits of ACP conversations are largely confirmed in general healthcare (Rietjens et. al, 2017). Utilizing existing interprofessional dialysis teams to deliver the primary level of kidney PC is the most promising way to improve dialysis patients’ quality of life. (Lam et al., 2019; Pfeifer & Head, 2018). The purpose of this project is to provide ACP communication skills training for the …

Reducing Weight Bias: Creating An Anti-Weight Stigma Educational Simulation For Nurse Practitioner Students, Andrea A. Eickelmann

Doctor of Nursing Practice Projects

Background: Large-bodied people make up the majority of the American population, but healthcare providers are rarely taught specific techniques and strategies for management of their care and medical spaces are designed with furniture and equipment that does not accommodate large bodies. This alienation has resulted in a measurable detriment to the population’s mortality and morbidity, such increased mortality of 60% from experiencing weight stigma and over 50% high combined cancer death rates as compared to the rates of those with normal BMIs (Sutinet al., 2015; Calle et al., 2003).

Objective: This project will examine the evidence about weight stigma, efficacy …

Examination Of Nurses’ Perceptions, Beliefs, And Conceptions Related To Rapid Bedside Implementation Of Prone Therapy During The Covid-19 Pandemic, Alyssa Poghen, Emily La Riviere

Doctor of Nursing Practice Projects

The COVID-19 pandemic of the SARS-CoV-2 virus created significant challenges for healthcare agencies and front-line healthcare workers. The SARS-CoV-2 virus has demonstrated a unique propensity to induce severe lung injury in the form of acute respiratory distress syndrome (ARDS). High rates of COVID-19 illness in the initial months of the pandemic in the United States led to a rapid influx of patients admitted to critical care units (CCUs) for ARDS. Prone positioning therapy (PPT) has shown substantial promise in treating refractory hypoxemia in people with severe ARDS but historically received poor acceptance as a first-line therapy. With the onset of …

Barriers For Individuals With Prediabetes From Enrolling In The Ymca’S Diabetes Prevention Program, Shokouh Pardakhtim, Negin Kourehpazan, Randal C. Claussen

Doctor of Nursing Practice Projects

Introduction: This qualitative research study examined barriers to enrollment in YMCA of Greater Seattle’s Diabetes Prevention Program (DPP) and how to improve the enrollment and referral process. Methodology: This was a quality improvement project that used qualitative methods in the research design. Semi-structured interviews and open-ended questionnaires were used to explore barriers in enrollment and to improve the referral and enrollment process from the perspective of participants with prediabetes referred to the DPP, YMCA staff who facilitate the DPP, and primary care providers who referred participant to the DPP. Results: A total of 10 interviews were conducted with the participants …

Implementation Of A Transitional Care Pilot Program To Reduce Heart Failure Readmissions, Kaylin Martin

Doctor of Nursing Practice Projects

Heart failure is a chronic collection of symptoms which primarily affect the elderly. The condition requires complex care and management, which is not only taxing on the patient but amass to large costs primarily from hospital admissions and readmissions. Readmissions are a key measurement in heart failure as Centers for Medicare and Medicaid with the Hospital Readmissions Reduction Program has enacted penalties to organizations with excess readmissions. Transitional care is a collection of interventions targeted at preventing readmissions and improving patient outcomes by early intervention and management after a patient has been hospitalized. This project established a pilot transitional care …

Barriers To Effective Implementation Of Contingency Management In Outpatient Treatment Of Methamphetamine, Emma A. Nauman

Doctor of Nursing Practice Projects

The objective of this project is to: 1) identify current understanding, attitudes, and beliefs of clinicians at a midsized urban outpatient substance use treatment clinic regarding contingency management (CM) treatment modality; 2) examine how this data contributes to barriers to implementation of contingency management for methamphetamine treatment; and 3) make recommendations to improve implementation strategies. A ten-question survey was developed based on Social Ecological Theory (U.S. Department of Health and Human Services, 2005), and was administered to 31 clinicians. A key informant interview was conducted using theoretical sampling (LoBiondo-Wood & Haber, 2018) of emergent themes. Three major barriers emerged from …

Pain Neuroscience Education As An Intervention For Chronic Pain, Corissa A. Sutton

Doctor of Nursing Practice Projects

Purpose: The purpose of this project was to evaluate the ability of Pain Neuroscience Education (PNE) to increase knowledge of pain as a biopsychosocial process and influence more health-promoting interpretations of pain among low-income adults as a preventative health education approach.

Background: PNE is a promising treatment approach for addressing chronic pain. However more data is needed to understand how to most effectively utilize this intervention.

Design: A program evaluation was conducted using a pre- and post- test design to elicit quantitative and qualitative data. Nine Seattle Housing Authority (SHA) buildings were invited to participate in two online pain neuroscience …

Grounds For A New Normal: Integration Of Telenephrology In Rural Communities, Carolyn J. Mattson

Doctor of Nursing Practice Projects

Patients with kidney disease represent a group of people who are known to have comorbidities, high costs of care, decreased quality of life, and invasive interventions. In rural communities of Western Washington State, many nephrology patients experience factors evidenced to impede access to quality and timely management of their disease, compounding the risk for poor outcomes. Telenephrology is a novel modality of service delivery with the potential to make care more efficient, cost-effective, flexible, and accessible. The author created this project to develop a telenephrology program plan and evaluation for rural settings in Western Washington, informed by relevant epidemiology, pathophysiology, …

A Provider Toolbox On Cardiovascular Disease Prevention In Women Of Color In The Primary Care Setting, Ellerey C. Nelson

Doctor of Nursing Practice Projects

Purpose: The purpose of this practice improvement project was to increase cardiovascular disease (CVD) knowledge in women of color (WOC) in the primary care setting through enhanced provider to patient education through implementation of a provider toolbox.

Background: CVD is the number one cause of death in women in the United States. However, WOC have a higher incidence of CVD than White women. Additionally, WOC have been found to have a decreased knowledge and awareness of CVD, demonstrated by numerous national studies. Therefore, the primary investigator (PI) identified a need to increase CVD knowledge and awareness in WOC in order …

Implementing Eating Disorder Screening And Early Intervention In A Primary Care Clinic, Brandon Dukovic

Doctor of Nursing Practice Projects

Eating disorders have a high mortality rate, increasing prevalence rate, and often go unrecognized and untreated. Primary care providers are uniquely positioned to intervene early in the development of these disorders yet screening for eating disorders in primary care is limited. This project looked to improve provider confidence and improve screening for eating disorders by introducing a provider education course focused on eating disorder screening, management, and resources, as well as implementing the SCOFF questionnaire into the annual health questionnaire completed by students utilizing a university health clinic. Pre-and post-intervention survey data showed an increase in provider self-reported confidence in …

Aiding Screening, Diagnosis, And Management Of Prediabetes Among High-Risk Medicare Patients In A Primary Care Setting, Manaye Utaile

Doctor of Nursing Practice Projects

Purpose: Encourage prediabetes screening, testing, and referral to a CDC-recognized Diabetes Prevention Program (DPP) as a first-line treatment.

Background: The prevalence of diabetes and prediabetes incidence is highest among Medicare-eligible Washingtonian patients, with 19% and 16%, respectively. DPP results in a 71% reduction of diabetes incidence in 65 years and older. However, only 3% of healthcare sites screen, test, and refer to DPP.

Design: Quality assessment with a descriptive quantitative evaluation method was conducted using Retrospective Chart Review for patients who visited Franciscan primary clinics from 08/31/2019 to 08/31/2020. A total of 1250 Medicare patients were extracted from a convenient …

Long-Acting Reversible Contraception Education For Street-Involved Youth: Impact On Knowledge, Attitudes, And Behaviors, Lizzie Simon

Doctor of Nursing Practice Projects

Despite evidence that long-acting reversible contraception (LARC) is safe, appropriate, and highly efficacious for people under age 25, this younger population is under-represented among LARC users in the US. At the Orion Clinic in Seattle, Kaiser Permanente offers primary care to street-involved young people between the ages of 12 and 24. Since opening in 2016, young patients at the Orion Clinichave initiated LARC at low rates, which reflects national trends. The aims of this project are to understand the reasons for this population’s underuse of highly effective contraceptive methods; to increase participants’ knowledge and positive attitudes toward LARC; and to …

Context Matters: Evaluating The Influence Of Patient Demographics And In-Patient Care Parameters On Breastfeeding Outcomes Associated With The Baby Friendly Hospital Initiative, Sarah Vivian Martin

Doctor of Nursing Practice Projects

Objective: Evaluate the effectiveness of the global Baby Friendly Hospital Initiative (BFHI) as an intervention to improve breastfeeding outcomes and to explore factors that are most supportive and predictive of exclusive breastfeeding.

Design: Program evaluation of the BFHI using a retrospective pre and post implementation electronic health record chart review.

Setting: A tertiary level hospital in WA. BFHI designation was achieved in November 2017.

Participants: Patients with a low-risk pregnancy, who gave birth (vaginal or cesarean) to a healthy term infant in Quarter one of 2015 (N=145) and Quarter four of 2018 (N=131).Patient and infant must have been discharged home …

Catching Up With Hpv Immunization: An Educational Video For College Students, Behrooz R. Soleimani

Doctor of Nursing Practice Projects

HPV is the most common sexually transmitted infection in the US, and it can lead to minor health problems such as genital warts and serious problems like cancer in men and women. HPV vaccination can effectively prevent HPV-related cancers and is recommended by ACIP to individuals aged 9-26. HPV vaccine uptake is low among adolescents and young adults in the US. College students have a window of opportunity to catch up with their HPV immunizations, and are often uninformed about HPV, the HPV vaccine, their eligibility to receive the HPV vaccine, and where they can obtain the HPV vaccine. An …

Gap Analysis, Development, And Evaluation Of An Advanced Practice Clinician Mentorship Program, Boyon Yun

Doctor of Nursing Practice Projects

Purpose: The purpose of this five-step quality improvement project is to identify and address gaps between the current and desired state of an advanced practice clinician (APC) onboarding process. Specific aims: (1) determine organization-specific needs of APCs, (2) develop a mentorship program for newly hired APCs, and (3) conduct a program evaluation (process and outcomes).

Background: Although the APC workforce is rapidly growing, health care organizations struggle with high APC turnover. Effective mentorship has been shown to help APCs, who are either new to practice or new to an organization (Pop, 2017).

Design: A needs assessment survey was distributed to …

Efficacy Of An Adult Congenital Heart Disease Transition Care Program: A Program Evaluation, Sarah Schwaegler

Doctor of Nursing Practice Projects

Transition Care Programs (TCPs) were created with the goal to facilitate transfer of care from pediatric care facilities to adult care facilities, as health deterioration is commonly seen in the adult with pediatric disease. University of Washington Medical Center and Seattle Children’s Hospital created a TCP for youths with congenital heart disease to aid in their transition to appropriate adult specialized care facilities. This program began in 2014 and had yet to have an evaluation. The purpose of this project is to evaluate the success of the current Transition Care Program from Seattle Children’s Hospital’s Heart Center to the University …

Implementation Of A Proactive Rapid Response Team Nurse Rounding Protocol To Address Afferent Limb Failure In A Mature Rapid Response System, Sarah Welch

Doctor of Nursing Practice Projects

Background: Rapid response system afferent limb failure (ALF) is associated with increased hospital mortality rates, unplanned transfer to the ICU, and increased hospital length of stay. Factors contributing to ALF are complex, including individual, team, organizational, and systemic barriers. The aims of this study were to evaluate the impact of implementation of a proactive rapid response team nurse (RRT RN) rounding protocol on the frequency of ALF preceding adverse events, patient disposition following RRT activation, and discharge disposition of patients experiencing adverse events during their hospital stay at a 281 bed community hospital.

Methods: This was a two part quantitative, …

Impact Of A Novel Application In Electrocardiogram Interpretation Confidence And Performance In Nurse Practitioner Students, Hailey Bobin Cole

Doctor of Nursing Practice Projects

For the last hundred years and to this day, one of the most important diagnostic tools in medicine has been the electrocardiogram (EKG or ECG). The decision to pursue a life-saving intervention, or not, may be heavily based on the interpretation of the results of a diagnostic test. With the weight of impacts to outcomes, one would think there would be ample, if not excessive, time and effort given to teaching practitioners how to interpret an ECG. Unfortunately, with each graduating class of physicians, nurse practitioners, and physician assistants, all of whom have within their scope of practice to interpret …

Screening For Adverse Childhood Experiences And Other Determinants Of Health In School Based Health Centers: A Program Evaluation, Olivia A. Domini

Doctor of Nursing Practice Projects

Introduction: Adverse Childhood Experiences (ACEs), such as abuse, neglect, and various household stressors, are common, connected, and contribute to multiple adverse health and wellbeing outcomes throughout life. Consequently, there has been a push to screen for adversity and toxic stress in primary care to facilitate prevention and early intervention. The purpose of this project was to evaluate and optimize the use of the Broad Level Integrated Screener (BLIS) in Neighborcare Health (NCH) School Based Health Centers (SBHCs) in Seattle, WA.

Methods: An online survey including nineteen Likert-scale questions and five open-ended free response questions was administered to all middle school …

Simulation Use In Pre-Licensure Nursing Programs: Assuring Excellence In New Nurse Competence And Confidence, Suzan Griffis Knowles

Doctor of Nursing Practice Projects

Purpose: This program evaluation project aims were to review the current state of simulation experiences in pre-licensure undergraduate nursing programs in Washington State and determine policy recommendations related to the future use of simulation experiences in clinical nursing education. The evaluation compared student outcomes of NCLEX pass rates associated with clinical simulation versus traditional clinical nursing experiences. Programs were evaluated for compliance with INACSL Simulation Standards of Best Practice.

Conceptual Framework: The NLN/Jeffries Theory provided the framework for an analysis of program evaluation data regarding using the INASCL Simulation Standards of Best Practice.

Design/Method: The study design was a descriptive …

Exploring The Influence Of Virtual Reality On Adults With Indications Of Early Stage Dementia, Nicole Chilivis

Doctor of Ministry Doctoral Projects

Virtual reality (VR) has the potential to transport people to compelling worlds and bring positive spiritual benefits to persons with dementia and their caregivers. The purpose of this qualitative phenomenological study was to understand the influence of VR on participants with indications of early stage dementia. This study explored how five elderly participants in a Seattle-based Program of All-Inclusive Care for the Elderly (PACE) program experienced immersive virtual reality by means of a Windows Mixed Reality headset. Using an episode from the 2016 VR series, theBlu—a colorful and immersive underwater experience with soothing audio accompaniment—each participant spent up to one …

Improving Transgender Healthcare Experiences Using Photovoice, Amy Nelson

Doctor of Nursing Practice Projects

The transgender community is one of many marginalized populations. There are a variety of factors that influence the healthcare experiences and quality of care that members of the community receive. Some aspects of the difficulties experienced are widespread and not limited to transgender individuals while others are exclusively experienced by transgender patients related to their unique needs. Transgender patients agree that issues identified by providers, like access to insurance and lack of protocols and provider education, are indeed barriers. However, transgender patients have identified other issues, like stigma and discrimination, to be more significant barriers to their accessing healthcare. Additionally, …

Nursing Satisfaction With The Electronic Medical Record: Implementing Meaningful Change At Seattle Children's Hospital, Mary T. Field

Doctor of Nursing Practice Projects

Purpose: The purpose of this study is to describe nursing use, quality, and satisfaction with the electronic medical record before and during the course of the electronic medical record transition. In addition, this study examines the differences between nurse age, role, and area of work as these demographics relate to nursing use, quality, and satisfaction.

Background: Nurses spend a large part of their shift using technology, including the electronic medical record, however the use, quality, and satisfaction of this tool as it relates to the nursing profession has not been formally evaluated.

Methods: The design of this study is an …

Evaluating The Impact Of A Depression Care Management Program, Natalie Dreyfoos

Doctor of Nursing Practice Projects

Depression is a common mental health disorder that causes significant individual and societal burden. Depression care management programs use a collaborative approach to lessen these effects. Evaluating patient satisfaction and experience are essential to obtain a comprehensive view of program benefits. This program evaluation project evaluated the experiences of patients in a depression care management program provided by a healthcare system in Washington state. A mixed methods approach using opened ended question surveys, telephone interviews and PHQ-9 scores provided a deeper understanding of individual experiences. The analysis showed patients were highly satisfied with the program. Collectively, depression severity scores decreased …

Improving Provider Confidence And Partnership With Lgbt Patients Through Inclusivity And Education, Katherine Rowe

Doctor of Nursing Practice Projects

The focus of this project utilizes patient recommendations for LGBT-inclusive intake practices to increase provider confidence in communication with LGBT patients using pre-and post-survey data comparing provider confidence before and after a 20-minute video education session. LGBT-inclusive provider education has been shown to be deficient if not nonexistent in most educational settings, yet, LGBT individuals have increased risk of negative health disparities, violence, and discrimination. Research examining the ability for small changes in provider education to enable positive health outcomes for this vulnerable and marginalized population is imperative for the quality of life of these communities. A quasi-experimental design utilized …