2020 DNP GRADUATING CLASS
Our 2020 DNP graduated class is compiled of bright and innovative individuals. Ponder DNP graduate project synopses below.
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Impact of Diabetes Self-Management Education on Adults with Diabetes and Mental Illness
Student: Brooke Tullis, BSN, RN
Chair: Eileen Walsh, PhD, APRN, CVN, FAHA
PICOT: Among adults ages 18 and older with a diagnosis of type 2 diabetes mellitus and any mental illness diagnosis, how does participation in an 8-week group DSMES course, compared to no DSMES course, impact self-efficacy, performance of self-care activities, and A1C levels at the end of an eight-week group DSMES course?
Description: Diabetes is the seventh leading cause of death and places a significant financial strain on the healthcare system with approximately $327 billion in estimated expenditures. Additionally, individuals with mental illness are at an increased risk for diabetes due to lower self-efficacy and limited performance of self-care activities compared to the general population. Diabetes Self-Management Education Support (DSMES) is recommended by the American Diabetes Association as an important aspect of diabetes care. In the Summer of 2020, individuals with diabetes and mental illness participated in an 8-week DSMES course. This course was found to have a significant improvement on self-efficacy (p = 0.003) as measured by the diabetes self-efficacy scale (DSES). There was not a statistically significant improvement in self-care activities.
Social Support Among Family Caregivers Who Attend Hospice Virtual Group Counseling
Sessions: Facilitators and Barriers to Attending These Sessions
Student: Katherine M. Hertzfeld, BSN, RN
Chair: Robert Topp, PhD, RN
PICOT: Among family caregivers of hospice patients who have since died and are attending a Hospice virtual group counseling session, what is their perceived social support and facilitators and barriers to attending these group counseling sessions?
Description: Family caregivers often suffer poor health outcomes if they do not receive enough social support following the death of a loved one. Using the Multidimensional Scale of Perceived Social Support, a demographic survey, and a qualitative survey, this mixed method study measured the perceived social support among family caregivers and barriers and facilitators they experienced in attending Hospice virtual group counseling sessions. While there was no significant correlation between demographic variables and the measures of social support, the qualitative findings indicated that the family caregivers were primarily in the action stage of the Transtheoretical Model.
Foot Care Confidence of Individuals with Diabetes in a Medically Underserved Area
Student: Rachel Ortega, BSN, RN
Chair: Eileen Walsh, PhD, APRN, CVN, FAHA
PICOT: In patients with diabetes ages ≥30 years seeking care at a free clinic within a medically underserved area in Lucas County Ohio, how does a one-time foot focused education session with provision of diabetic socks and an unbreakable telescopic mirror compared to current practice impact foot selfcare knowledge, confidence, and behavior at 30 days following the education session?
Description: The Theory of Planned Behavior and the Iowa Model guided the implementation of a one-time foot focused education session with provision of diabetic socks and an unbreakable telescopic mirror. Participants completed two visits. Knowledge of Foot Care, Foot Care Confidence Survey and Foot Care Behavior questionnaires each visit. Results from the pre-intervention answers and 30 day post intervention answers were compared using a one-tailed t-test. Twelve patients (7 females and 5 males) completed both visits. Both knowledge of foot care (p=0.03) and preventive foot care behavior (p=0.02) increased. A one-time foot care education session with provision of diabetic socks and an unbreakable telescopic mirror may be helpful strategy to increase foot care behaviors in patients with diabetes in a medically underserved area.
Use of Comprehensive Care Coordinator Telephonic Outreach to Increase Colorectal Cancer Screening in Primary Care
Student: Sarah N. Klotz, MSN, APRN-CNP
Chair: Eileen Walsh, PhD, APRN, CVN, FAHA
PICOT: Among patients 50 to 75 years of age eligible for CRC screening (P), how does comprehensive care coordinator telephonic outreach (I), compared to current practice of mailing a standard letter about CRC screening (C), affect 1. CRC screening rates, 2. Utilization of Target Health System colonoscopy services 3. Reimbursement of colonoscopy services, and 4. Impact of screening (O), over a 90-day period (T).
Description: One-hundred patients, 50-75 years of age received comprehensive care coordinator telephonic outreach. Outcomes were measured at 90 days post intervention and compared to the existing outreach. The EBP QI project demonstrated a 5-fold increase in CRC screening rates and significant retention of services within the Target Health System. The improvement in colonoscopy screening resulted in an estimated increase of over $5,000 in reimbursement to the Target Health System. The impact of screening was significant with over 70% of individuals (n=5) needing surgical excision of polyp(s) during colonoscopy services.
Orthopedic-Trauma Opioid Prescribing Guideline Adherence Initiative
Student: Anita Marie Stechschulte, MSN, APRN-CNP
Chair: Linda Lewandowski, PhD, RN, FAAN
PICOT: In a population of adults ages 18 to 64 currently on opioid therapy, in an ambulatory orthopedic-trauma clinic, does provider education on current standardized opioid prescribing guidelines improve provider knowledge, comfort, and confidence with opioid monitoring, improve the use of standardized monitoring practices, and improve the use of risk mitigation strategies for this population eight weeks after the initial four weeks provider education intervention?
Description: A four-week provider education intervention was implemented based on the CDC opioid prescribing guidelines June 2020. Provider knowledge, comfort, and confidence was measured via a pre- and post-survey and had changed although project participation proved to be a barrier. The low provider participation rate was suspected to have been influenced by the Coronavirus' global pandemic outbreak. Despite low education rates, adherence to prescribing guidelines had improved and risk mitigation had improved. Among those patients who had been screened 3% had the potential for opioid misuse and 20% were found to be at risk for overdose. The use of opioid prescribing guidelines had improved outcomes by identifying those at risk for overdose and for opioid misuse.
The Effect of a Multi-Modular Text Message Intervention on HPV Vaccinations
Student: Sarah Bennett, BSN, RN
Chair: Temeaka Gray El, PsyD, MBA, MSN, APRN-CNP
PICOT: In parents of children 9-14 years of age, what is the effect of an individualized theory-based educational reminder on HPV vaccination rates and parental perceptions of the HPV vaccine compared to no educational reminder within a six-week intervention period?
Description: A six-week intervention guided by the Health Belief Model that included individualized theory-based education and reminder texts was implemented at two pediatric primary care sites. Participants completed a pre and post-survey that included the Parental Human Papillomavirus Vaccine Survey (PHPVS). Mean PHPVS scores showed clinically significant increases with improvement in the likelihood of HPV vaccination. HPV vaccination rates increased at one pediatric primary care office, but project participation proved to be a barrier. Future recommendations focus on incorporation of the PHPVS in the clinic setting and the utilization of a text message reminder system to increase HPV vaccine rate uptake and completion.
Evidence Based Practice Improvement Project to Improve Influenza Vaccination Rate in Intercollegiate Athletes
Student: Cliff Fawcett, MSN, Med, APRN, FNP-BC
Chair: Susan Batten, PhD, APRN-CNS
PICOT: In intercollegiate athletes, how does implementation of a multicomponent intervention designed to increase influenza vaccination rate compare to the current influenza vaccination effort in regard to vaccination rate of the intercollegiate athlete population within the 2019 - 2020 influenza season?
Description: The Advisory Committee on Immunization Practices recommends annual influenza vaccination for all individuals greater than six months who do not have contraindications. Strong evidence supports the safety and efficacy of the influenza vaccine, yet the uptake of the vaccine is low across many populations, especially college students. Healthy People 2020 influenza vaccination initiative goal is 70% vaccination rate. The American College Health Association influenza vaccination goal is 44%. In order to address the low influenza vaccination rate among intercollegiate athletes a multi-component evidence based practice improvement project was implemented at a private university in rural Ohio. As a result of the implementation of the flu vaccine initiative vaccination rate among intercollegiate athletes increased from 13.4% in 2018 -2019 to 25.6% in 2019-2020.
Teach-Back Method and Brown Bag Review in the Psychiatric Population: An Evidence-Based Practice Project
Student: Kori Pfeiffer, BSN, RN
Chair: Linda Lewin, PhD, PMHCNS-BC
PICOT: In substance abuse patients at an inpatient detoxification facility, does implementation of the teach-back method and brown bag review from the Health Literacy Universal Precautions Toolkit, compared to pre-intervention data, improve Medication Adherence Rating Scale scores and decrease medication errors?
Description: Between October 2019 and February 2020, participants from an inpatient detoxification unit were enrolled in this evidence-based practice project, which was conducted during two sessions using the Teach-Back Method and Brown Bag Review. The participants were evaluated by comparing their baseline and post-intervention medication errors and medication adherence scores. Participants’ health literacy levels were measured using the Single Item Literacy Screener (SILS). The difference between participants’ medication adherence rating scores at baseline and post-intervention was significant (p = .039) using the Wilcoxon Signed-Rank Test. The difference between baseline and post-intervention errors was clinically significant but not statistically significant (p = .059) using the Wilcoxon Signed-Rank Test.
The Effect of The Rapid Assessment for Adolescent Preventive Services (RAAPS) in Improving the Style of the Exchange of Information and Balance of Power during a Health Care Visit in a Pediatric Primary Care Setting
Student: Brandi Snyder, BSN, RN
Chair: Robert Topp, PhD, RN
PICOT: Among adolescents, ages 13-18, in a pediatric primary care setting, does the implementation of the Rapid Assessment for Adolescent Preventive Services (RAAPS) in comparison to current standard of care result in improved style of the exchange of information and balance of power when addressing adolescent high-risk behaviors during an annual preventive (wellness) visit in primary care?
Description: The RAAPS can support providers screening for adolescent high-risk behaviors through facilitating the exchange of information during an office visit. The Adolescent Patient-Provider Interaction Scale (APPIS) measures the style of exchange of information and balance of power during an office visit. Initially, fifteen adolescents completed the APPIS following their office visit. A second group of five adolescents completed the RAAPS during the check in process at the clinic and then completed the APPIS following their visit. Their responses on the RAAPS were reviewed by the provider prior to meeting with the adolescent patient. There were no differences (p<.05) between the two groups on the APPIS. This lack of effect of the RAAPS intervention may be attributable to the small sample size.