Depression Screening Tool For Hysterectomy Patients, Dede C. Mihedji

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The prevalence of hysterectomies in the United States ranges from

5.1 to 5.8 per 1000 women (Harnod et al., 2018). A standardized screening tool for assessing

depression preoperatively could mitigate the worsening of postoperative depressive symptoms in patients scheduled for a hysterectomy.

Local Problem: Currently, there is no standard of practice to routinely screen for depression in preoperative patients scheduled for hysterectomy surgeries. However, as with any surgical intervention, there are risks of long-term complications. Studies have identified that a hysterectomy may increase the risk of cardiovascular events, menopause, depression, and other outcomes (Madueke-Laveaux et al., 2022). …

Implementation Of A Community Health Worker (Chw) Training Program To Improve Birth Outcomes, Emiko Maruri

Doctor of Nursing Practice (DNP) Projects

Background

Those who have been affected by any adverse childhood experience (ACE) have an increased likelihood of poor birth outcomes. These include low infant birth weight, preterm delivery and can even lead to pregnancy loss.

Problem

Latina women have been identified by the Centers for Disease Control (CDC) as those most affected by ACEs. Further evidence supports those affected by 2 or more ACEs have poor birth outcomes.

Context

For this project, The Save the Children organization in partnership with the University of San Francisco Doctorate of Nursing Practice (USF DNP) students and Community Health Workers (CHWs) of the Central …

Implementation Of Fast-Track Triage Process To Improve Ambulance Patient Offloading Time (Apot) In A Psychiatric Emergency Services (Pes) Unit, Oke Augustine Umeugoji

Doctor of Nursing Practice (DNP) Projects

Abstract.

Background.

Ambulance delays in hospital EDs have recently been significant in the United States. This delay has been attributed to emergency department overcrowding, a record number of 911 calls, a shortage of ED staff (doctors and nurses), and poor resources available in the communities as alternatives to an ED visit. Local Emergency Medical Service Authorities (LEMSA) monitor and determine the community standards for measuring ambulance offload delays (AOD), usually in minutes.

Problem.

Lengthy ambulance patient offload times and their subsequent impact on EMS have been significant all around the state of California as well as nationwide. The ambulance delay …

Promoting Parent-Child Relationships Through Community-Based Family Wellness Programs To Improve Mental Health In Children, Maria Elena Falcon

Doctor of Nursing Practice (DNP) Projects

Objective: Adverse childhood experiences can affect a child mentally and lead to mental, health, and learning problems later in life. Establishing healthy parent-child relationships through family-oriented programs can promote mental well-being, improve behavior and learning in children and strengthen positive parent-child relationships.

Methods: A systematic electronic search using databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and PsycINFO, contextualized current research on the importance of parent-child relationships and their influence on mental health. The inclusion criteria for the review used were articles in the English language and relevant dates from 2014 to 2021. The key terms used …

Save The Children Community Health Worker Program – Adverse Childhood Events Prevention, Jieun Lee

Doctor of Nursing Practice (DNP) Projects

Background: Adverse childhood experiences (ACEs) are potentially traumatic events that occur between the ages of 0 to 17 in which are directly associated, in a dose–response manner, to many of the most common and serious health problems in the United States.

Local Problem: 62% of California residents have experienced at least one ACE, and 16% have experienced at least four ACEs. ACEs are linked to nine of the ten leading causes of death in the United States Adults with four or more ACEs are 37.5 times more likely to attempt suicide, 3.2 times more likely to have chronic lower respiratory …

Mental Health Services: Reaching The Homeless, Gurdeep Mann

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Serious mental illness (SMI) and substance use disorder (SUD) are two common findings among the majority of those experiencing homelessness in the Stanislaus County.

Local Problem: Emergency shelters typically do not provide mental health services on-site, however, a collaboration between First Behavioral Health Urgent Care Center (FBH) and We Care Program Turlock (WCPT) was established to provide mental health services on-site.

Method: The WCPT case manager as part of a Doctor of Nursing Practice (DNP) quality improvement project implemented Assertive Outreach Model interventions to increase utilization of mental health services and established long-term relationships.

Interventions: Frequent contact with …

Trauma-Informed Treatment For Alcohol Use Disorder: Improving Long-Term Recovery, Aline M. Bales

Doctor of Nursing Practice (DNP) Projects

Background: This DNP project aimed to assess the feasibility of implementing trauma-informed care to Ria Health's telehealth AUD MAT recovery treatment model for patients with co-occurring PTSD, targeting high relapse rates due to cravings. Trauma-informed care addresses traumatic histories that can potentiate emotional dysregulation leading to maladaptive coping responses manifesting as cravings with addiction memory.

Methods: An integrated review assessed the prevalence of co-occurrence of AUD and PTSD, assessed interest in Ria Health patients, patients recruited from Ria Health if they mentioned cravings, offered concurrent trauma-informed care with medicated assisted treatment for 16-20 sessions, trauma-informed care used Polyvagal Theory techniques …

Community Health Worker Program - Substance Use Disorder In Pregnancy, Alicia Claire Kletter Dnp

Doctor of Nursing Practice (DNP) Projects

Background Substance use disorder (SUD) in pregnancy is a concern for mother, baby and community. Healthcare policies are increasingly calling for diversification of the workforce to meet healthcare needs. Community health workers (CHWs) are understood from the literature to be effective at bridging the gap between patient and healthcare provider, especially for vulnerable populations. Local Problem California’s Central Valley is majority Latinx and faces challenges from poverty, lack of medical resources, unemployment and SUD at rates which are higher than other communities. Combine SUD with pregnancy and the need for robust social connections, psychological support, and physical healthcare become even …

Standardizing Behavioral Health Triage: Using The Heads-Ed Tool, Sarah K. Peifer

Doctor of Nursing Practice (DNP) Projects

Background: In the past two years emergency departments across the country have experienced an increase in pediatric patients requiring behavioral health care. It is essential to provide efficient, early intervention to these vulnerable patients. The use of a standardized tool can improve management of pediatric patients and allow access to resources in a timely manner.

Purpose: To evaluate the implementation of the HEADS-ED in a community hospital ED, to provide rapid behavioral health assessment.

Methods: Education for staff was provided through various platforms and involved regular support for staff throughout the intervention. It was hypothesized that implementation of …

Changing Minds, Changing Lives: Increasing Resilience In Undergraduate Nursing Students Through The Implementation Of A Resilience Educational Intervention Program, Jennifer Rivera-Perez

Doctor of Nursing Practice (DNP) Projects

Background: Nursing students suffer from high levels of stress and psychological distress, especially those with histories of childhood adversity. The COVID-19 pandemic has been an additional source of stress on students. Students who suffer from psychological distress are at greater risk of engaging in maladaptive behaviors that may lead to physical and psychological conditions. Despite this data, college campuses lack resilience intervention programs, which have been shown to reduce psychological distress, perceived stress, and increase resilience. Purpose: The purpose of this Quality Improvement project was to implement a well-established evidence-based resilience program for nursing students, and to evaluate the feasibility …

Reducing The Risk Of Fentanyl Related Overdose In Medication Assisted Treatment Programs Based On Principles Of Motivational Interviewing, Anna B. Snow, Chelsea Betsold

Doctor of Nursing Practice (DNP) Projects

Background: The increase in fentanyl exposure by individuals who use illicit drugs has risen causing a significant increase in the number of overdoses and overdose-related deaths. Drug checking for the presence of fentanyl can allow drug users to make more informed decisions especially when combined with motivational interviewing.

Purpose: The purpose of this project was to assess the effectiveness of an educational program for clinical staff regarding the use of fentanyl test strips based on the principles of motivational interviewing.

Methods: The project was completed at a Medication Assisted Treatment (MAT) program in an outpatient behavioral health facility in New …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …

Developing A Culturally Relevant Mental Health Assessment For Persons Of African Descent, Roberta Iyamu

Doctor of Nursing Practice (DNP) Projects

Abstract

Problem: Persons of African descent have lower access to mental health care, are less likely to receive needed care, and are more likely to be misdiagnosed, experience severe disease, and to receive mental health care through primary care than non-Hispanic Whites. Context: Cultural norms related to mental health as well as the lack of culturally congruent health care delivery contribute to lower mental health care access and uptake among persons of African descent. Interventions: Campinha-Bacote’s cultural competence model and the BATHE technique provided the theoretical framework for the development and implementation of a nurse practitioner (NP) (n = 4) …

A Toolkit To Assist Child And Adolescent Providers In Assessing Problematic Internet Use And Cyberbullying In An Outpatient Psychiatry Clinic, Collin J. Mcgrath

Doctor of Nursing Practice (DNP) Projects

Social media has become a transformational part of daily life in the United States. Currently, there are few assessment tools and no standard of care when it comes to assessing internet use, social media, and cyberbullying among child and adolescent patients. Problematic internet use (PIU) and cyberbullying can both significantly and negatively impact the mental health of children and adolescents. The purpose of this project is to evaluate the effectiveness of an online toolkit implementation for a Southwest Florida (SWFL) outpatient psychiatry office. A pre/post one group design was used. A convenience sample of 13 healthcare providers was recruited from …

Enhancing Therapeutic Alliances In Neonatal Care: Parents With Substance Use Disorders, Shannon A. Starkey

Doctor of Nursing Practice (DNP) Projects

Background: The number of newborns exposed to opiates quadrupled in the United States from 1999 to 2014, from 1.5 per 1,000 hospital deliveries to 6.5 per 1,000. Many of these babies are admitted to the neonatal intensive care unit for neonatal abstinence withdrawal syndrome. While neonatal nurses are trained to care for babies exposed to substances in utero, they often struggle to meet the unique psychosocial needs of the babies’ parents. Negative attitudes and strained interactions between neonatal nurses and families with substance use disorders (SUDs) result in subtherapeutic alliances and suboptimal outcomes in neonatal nurseries. Purpose: Educational …

A Quality Improvement Project To Assess The Value Of Pharmacogenomic Testing In Adults Diagnosed With Major Depression, Ileana Miranda Velazquez

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Treatment of major depression follows the guidelines from evidence-based medicine established algorithms; however, 50% of patients diagnosed with major depressive disorder do not respond to their first medication trial, and 70% may go through four treatment attempts before achieving remission.

Purpose: To demonstrate the value of pharmacogenomic testing as a treatment-guidance technology in patients with resistant depression and assess healthcare providers' motivation to adopt the technology.

Methods: A retrospective chart review of (N = 73) patients' treatment response measured by the pre-post PHQ-9 depression scale after pharmacogenomic guided medication intervention with descriptive statistics and paired t-test. The …

Development Of A Pediatric Depression Healthcare Toolkit, Maria Theresa Kennedy

Doctor of Nursing Practice (DNP) Projects

Background: Depression is a debilitating and life-threatening disease that strongly affects youth in the United States. Low socioeconomic populations often have high-risk factors for depression, low health literacy, and poor access to care. Risk factors are amplified for those who identify as gender non-binary or lesbian, gay, bisexual, transgender, or queer (LGBTQ). Psychoeducation can empower youth to be active participants within their treatment.

Purpose: The focus of this project was to evaluate a newly developed healthcare toolkit for pediatric depression in the format of an eBook for mental health professionals.

Methods: An eBook focusing on depression pathology, symptoms and …

Fostering Resilience In The School-Aged Child, Patricia D. Schneider

Doctor of Nursing Practice (DNP) Projects

Background: The world is a challenging and sometimes difficult place to navigate. People are faced with tragedies and adversity. Without supportive people and environments, this can lead to poor outcomes such as physically, socially, and emotionally. Children rely on adults to provide safety, love, and security yet many children do not receive the care they need and deserve. Adversity in children affects their development and reduces their capabilities to deal with stress. For a society to prosper and grow, reducing child adversity is essential. Resilience is a powerful tool that can be fostered and developed in children, so they are …

Workplace Violence: An Urgent Call For Integrated Staff Education In Acute Care Hospitals, Nicole Bellisario

Doctor of Nursing Practice (DNP) Projects

Problem: Type II workplace violence (WPV) in acute care hospital settings has become an epidemic of costly proportions in the United States. Regulatory mandates and healthcare accreditation standards increasingly require healthcare employers to provide a safe and healthy healing environment for patients and a safe work environment for staff. Implementation of a comprehensive WPV prevention program depends largely on organizational culture, participation and commitment from key stakeholders, and readiness for change.

Context: The patient-clinician relationship has drawn urgent attention, as healthcare organizations around the world implement key components of WPV prevention programs. The clinical management of patient aggression …

Cultural Communication For New Nurse Residents: K.I.N.D Communication Toolkit, Jennifer Caraballo

Doctor of Nursing Practice (DNP) Projects

Background: Microaggressions can create a hostile work environment and decrease rapport and functioning in clinical and personal relationships. Exposure to micro aggression and implicit bias results in micro trauma and possible compassion fatigue by medical staff. Symptoms can include headaches, poor sleep, depressions, and anxiety, similar to compassion fatigue.

Purpose: To develop a toolkit for healthcare staff to use as educational material to facilitate for cultural communication and cultural humility.

Methods: Nurses that were enrolled in a nurse residency program at a level 1 trauma center participated in the education of a communication toolkit related to K.I.N.D …

School-Based Telemental Health And Family Psychoeducation: A Program Evaluation, Ainat Koren

Doctor of Nursing Practice (DNP) Projects

Background: Telemental Health has been established as an effective model of care in the adult population. There are few studies that addressed the effects of providing child and parent telehealth services in underserved communities where mental health services are sparse. Families who attend face to face mental health support report high levels of satisfaction, show increased knowledge about mental illness/treatment, and youth have a lower risk of relapse.

Purpose: The purpose of this DNP project was to evaluate an innovative Telemental Health model offering timely social/behavioral health support for children/families’ mental health services in rural Massachusetts.

Methods: Process …

Mitigating Prescription Opioid Risk: Prescription Drug Monitoring Programs, Brenda Vigue

Doctor of Nursing Practice (DNP) Projects

Background: Opioid-related morbidity and mortality is a serious public health issue in the United States. Prescription Drug Monitoring Program (PDMP) review prior to prescribing opioids has consistently been recommended as best practices for risk mitigation, however, access/utilization of this monitoring program remains low.

Methods: This quality improvement (QI) project for improved PDMP utilization employed a pre-post survey design in a random sample of Advanced Practice Registered Nurses in Arizona. Quantitative measures included online surveys with close-ended responses to salient items from the review of literature and best practices. A follow-up survey was requested of the participants who provided their …

School-Based Suicide Prevention Program Implementation: Improving Awareness Among Parents And Faculty, Nicole Neuman

Doctor of Nursing Practice (DNP) Projects

The health development and critical transition period of preteen to adolescence are subject to adverse experiences and prevalent risk behaviors that may negatively influence mental health. Emerging issues of depression and suicide among school-aged youths present a global epidemic. Well-designed interventions, such as school-based programs, align with national strategies and health initiatives to reduce suicide rates and facilitate treatment of concerning symptoms. Database searches for school-based, suicide, depression, prevention, and screening literature from 2012-2017 identified 12 relevant studies selected for review. Mental wellness and suicide prevention curricula must successfully improve wisdom, enhance coping skills/resilience, and foster relationships which support help-seeking …

Screening Adults With Substance Use Disorder For Adverse Childhood Experiences, Teri Murtha

Doctor of Nursing Practice (DNP) Projects

Background and purpose-Exposure to adverse childhood experiences results in increased morbidity and mortality among individuals with substance use disorders. Screening for histories of childhood trauma, and integration of trauma-informed care is lacking among health care practitioners. Integrating screening for histories of childhood abuse in person’s seeking treatment for substance abuse disorders can facilitate identification of individuals interested in additional support and resources to support their recovery. The purpose of this study was to assess the effectiveness and feasibility of a screening interview protocol for ACEs and to determine the presence of ACEs among individuals with substance use disorder (SUD) …

Evidence-Based Verbal De-Escalation Techniques For The Family Nurse Practitioner: Education And Simulation, Rachael K. Misitano

Doctor of Nursing Practice (DNP) Projects

Background: Healthcare workers are 4 times more likely to be exposed to workplace violence than workers employed in private industry, with assault rates as high as 7.8 per 10,000 workers. The National Institute for Occupational Safety and Health defines workplace violence as “violent acts, including physical assaults, and or threats of assault, directed toward persons at work or on duty” (OSHA, 2015, p. 2). Verbal de-escalation techniques that assist with care of the agitated patient are not routinely taught to Family Nurse Practitioners (FNPs) throughout their years of advanced coursework, yet it is something they are likely to encounter …

An Integrative Review With Toolkit For Caregivers Of Persons With Dementia, Lea Grippin

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The risk of burnout among caregivers of people with dementia is on the increase. Dementia is a progressive neuropsychiatric disorder affecting the cognitive function resulting in confusion and disorientation leading to greater demands on the caregiver which can lead to depression, social isolation, stress, worsening personal health, anxiety, fatigue, financial losses, and potential for abuse.

Methods: This project focused on creating a toolkit for nursing staff caring for patients with dementia followed by a presentation designed to provide options for caregiver support that can assist the caregiver in decreasing their feelings of stress and burnout. This included strategies …

Identification And Ptsd Screening Of Military Veteran Patients In Community Healthcare: A Quality Improvement Project, Caitlin Rose Budrewicz

Doctor of Nursing Practice (DNP) Projects

Background: Military veterans are at an increased risk for post-traumatic stress disorder (PTSD) related to their prior military service. Establishing veteran status of patients cared for in civilian healthcare and screening for PTSD will increase the likelihood of identifying symptoms and prompt appropriate treatment. Purpose: The focus of this project is to increase practitioner awareness and knowledge of PTSD in veteran patients as well as to identify and screen veteran patients for PTSD symptoms utilizing the primary care PTSD screen (PC-PTSD). Method: To determine veteran status, patients over the age of 18 years in an internal medicine clinic will be …

Increasing The Awareness Of Trauma Informed Care In The School Setting: Giving Practitioners The Tools To Actively Participate In Trauma Related Care, Rebekah L. Sypniewski

Doctor of Nursing Practice (DNP) Projects

Of the approximately 15 million children and adolescents who have a mental health disorders that are interfering with their functioning, a mere 25% seek medical advice or treatment (Melnyk, Kelly, & Lusk, 2014). Furthermore, two thirds of youth report experience at least one traumatic event by age 16 (Suarez, Belcher, Briggs, & Titus, 2012). School health practitioners have regular contact with children and adolescents as they typically attend school five days a week, nine months out of the year. The consistent presence of the relationship between the practitioner and student creates an ideal environment for discussing the sensitive topics necessary …