DNP Student Projects


2018 DNP Recipients:

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JoseJose Balderrama

DNP, NNP-BC, RN

Title: Improving NAS outcomes in the NICU: A practice improvement project

Abstract: Neonatal abstinence syndrome (NAS) is a preventable health condition affecting newborns exposed to licit/illicit opioids in utero.  With an alarming increase in opioid incidence observed throughout the U.S. since 2000, the incidence of NAS parallels the overall incidence.  The effects of NAS are devastating and lifelong.  Adding to the dilemma, healthcare expenditure and overuse of resources has increased exponentially as well.  The purpose of the practice improvement project is to update NAS policy and improve staff NAS scoring and training as the intervention.   

The goals include reducing the length of stay (LOS) and the length of treatment (LOT) for affected infants.  Myra Levine’s Conservation Model and Kurt Lewin’s Change Theory are utilized for this project.  This practice improvement project recruited nurses working in a southern New Mexico NICU, L&D, and pediatric units assigned to the NICU as permanent or temporary staff.  Pre and post-test are administered to gauge the nurses’ improvement of NAS education and NAS scoring.  Three month pre intervention with three month post intervention comparison in LOS and LOT are compared.  Additionally, participant demographic data is included to aid education and training to specific shifts and departments.

The findings revealed that NAS education, training, and adherence to policy may improve LOS and LOT.  Unfortunately, a timeframe measured in years will be required to provide a more accurate assessment of the impact on the LOS and LOT of infants with NAS in the NICU.

 

GhirmayGhirmay Ghebreslasse

DNP, MSN, RN

Title: The development and integration of a downtime policy/procedure for electronic medical/medication administration Record in a rural mental health hospital

Abstract: Patient safety is an essential element of quality healthcare. However, medication errors continue to be one of the most common patient safety risks in hospitals. One complication that contributes to medication errors is lack of availability of electronic patient records.  Research indicates the use of an electronic health records (EHR) and electronic medication administration records (EMAR) downtime policy/procedure minimize the rate of medication errors. The local mental health hospital is integrating EHR software, necessitating the need for downtime policy/procedure development. The objective of this Doctor of Nursing Practice (DNP) project was first to develop the EHR/EMAR downtime policy/procedure, then to educate clinical staff in preparation for the upcoming software implementation.

The DNP project facilitator, the Chief Nursing Officer (CNO), and the Information Technology (IT) Officer at the local mental health hospital collaboratively developed the downtime EHR/EMAR policy/procedure. Once the policy was developed, a one-hour training session was provided to the clinical staff. The training session was offered on two separate days to allow for work schedules. Prior to the training session, consent was obtained from the participants for the completion of a pretest/posttest survey to evaluate perceived use and knowledge of the EHR/EMAR downtime policy/procedure. 31 clinical staff members attended the trainings.

The findings of the post-test indicated that clinical staff members’ perceived usefulness and knowledge of the EHR/EMAR downtime policy/procedure improved. Prior to the training, 51.6% (n=16) responded with “not sure” regarding perceived usefulness of downtime forms. After the training, 80.6% (n=25) responded with either “effective” or “very effective.”  The post-test indicated that participants had an improved knowledge of the EHR/EMAR downtime policy/procedure, with 90.3% (n=28) reporting their level of knowledge as “somewhat knowledgeable” or “knowledgeable.”

Clinical staff members’ perceived usefulness and knowledge is important for the implementation and usage of the EHR and EHR/EMAR downtime policy/procedure. Although staff members’ perceived usefulness increased, the results indicate that further education and training is vital prior to adoption of the EHR/EMAR downtime policy/procedure.

 

ErikaErika Marie Poling

DNP, MSN, CHNP,
RN

Title: A Standardized delirium screening tool and intervention checklist in hospice impatient care

Abstract: Delirium is a frequent problem that is seen among hospice patients during their final months to days of life, yet it is something that is under recognized and under diagnosed (Gaudreau, Gagnon, Harel, Tremblay & Roy, 2005). In the hospice setting there was a need to understand how to identify causes of delirium to minimize symptoms and increase the quality of time prior to death (Hosie et al., 2012). The purpose of this DNP project was to implement the Nu-DESC (2005) and CHIMBOP (2008) assessment checklists in the daily care routine in the inpatient setting.  Delirium is common across various healthcare settings; however, the care location greatly determines the utility of the tool under study (Grover & Kate, 2012).  Delirium is often as a syndrome and is displayed as different symptoms resulting from a greater medical issue (Hosie et al., 2014b).  According to Close and Long (2012), there are predisposing and precipitating factors when determining risk of delirium occurrence.

The healthcare professionals practicing in this area of care are looked to as the experts in hospice care by patients and their loved ones during a terminal illness (Desbiens, et al., 2012).  Using nursing theoretical framework and a learning model, the Nu-DESC (2005) and CHIMBOP (2008) were implemented in the inpatient unit of a hospice facility. Analysis showed knowledge acquisition after educational in-service, with post-test scores showing improved knowledge with the low score at 71%, high score at 93.5% (SD=8.12) and average score of 84.2%.  However sustained knowledge decreased over a three-month period with the highest score on the 3-month post-test seen of the five return participants being 87.1%, while the lowest score was 74.2%.  The mean was calculated at 81.9% with a standard deviation of 5.87. Further research is needed to evaluate the Nu-DESC in screening this patient population.

 

LindsayKristen Smith-Yawea

DNP, BSN, RN

Title: Implementation of a brief childhood trauma screening tool and trauma-informed care staff development on adult inpatient psychiatric units

Abstract: Traumatic childhood experiences pose a significant societal issue with lasting effects. Victims of traumatic childhood experiences have disproportionately higher rates of mental illness, substance use disorders, and other chronic medical conditions.  A literature review regarding adverse childhood experiences and its interrelationship between mental health and substance use disorders was conducted.  The Adult Inpatient Psychiatric Units at the University of New Mexico Hospital (UNMH) were not screening for traumatic childhood experiences.  Key interviews were completed with the university psychiatric center’s management personnel to explore the necessity for a traumatic childhood experiences screening tool.  Moreover, nursing and advanced practice nursing staff training transpired surrounding the implementation of a chosen traumatic childhood experiences screening tool in determining the staff’s willingness and comfort before and after the staff training. Staff development concerning trauma-informed care interventions by assessing staff’s willingness and knowledge-base before and after the training was discussed as well.  The identified screening tool was recommended to screen for all inpatient admissions on the adult inpatient units of the university psychiatric center.

            The results of the DNP project demonstrated the nursing and advanced practice nursing staff on the Adult Inpatient Psychiatric Units at UNMH acquired an increase in knowledge regarding trauma-informed care interventions and ongoing readiness to offer these interventions when caring for their patients after participating in the trauma-informed care training.  These results further demonstrated the nursing and advanced practice nursing staff had an increase in level of comfort and willingness to screen for traumatic childhood experiences after the trauma-informed care training and piloting of the TSC-40 screening tool when comparing the pre and post-survey responses.  A future endeavor may entail presenting the TSC-40 screening tool to the Clinical Informatics Committee at UNMH to assess whether this screening tool can be integrated into the nursing charting of the electronic medical record.

 

LindsayLindsey Schweiger-Whalen

DNP, BSN, RN

Title: Converging cultures: Partnering in affirmative and inclusive health care for members of the lesbian, gay, bisexual, and transgender population

Abstract: Members of the lesbian, gay, bisexual, and transgender (LGBT) community suffer from disproportionate rates of physical and mental illness. This population experiences enhanced vulnerability to illness as a result of societal marginalization, known as minority stress (Meyer, 2003), which is compounded by insufficient LGBT education for health care professionals and stigmatizing experiences within medical institutions.

The 4-hour pilot workshop, “Converging Cultures,” was implemented among a sample of self-selected hospital employees and a convenience group of nursing students. The intention of the project was to develop LGBT cultural competence according to the five fundamental constructs of Campinha-Bacote’s (2002) theory, The Process of Cultural Competence in the Delivery of Health Care Services. A pretest-posttest design was used to capture data on effectiveness of the intervention. The GAP scale, a measure of LGBT-affirmative practice beliefs, and an objective Knowledge Quiz were administered before and directly following the training. The posttest included three open-ended questions to elicit self-reflection and development of cultural competence. Paired sample t-tests revealed significant improvement on the GAP and Knowledge Quiz with no significant differences found among demographic subgroups. Open-ended responses reflected the five constructs of Campinha-Bacote’s theory. Future educational efforts for sexual and gender minorities should strive to avoid inadvertent marginalization of LGBT people through integration of concepts with existing curricula and workplace training. 

RuthRuth Burkhart

DNP, LPCC, RN

Title: Health care reform in New Mexico: Threat or opportunity for the nurse role in community health?

Abstract: The purpose of this Doctor of Nursing Practice project was to describe the need for DNP nurse leadership to advocate for a nurse generalist role in the reform of New Mexico’s health care system under ACA 2010. The framework for the project was the nurse role within the context of a national and global shift of health care focus to population health and social determinants of health, and an anticipated shift of reimbursement and workforce priority to primary prevention, where few roles for nurses currently exist.

The project laid a foundation for a nurse generalist role in community based systems of care, utilizing the Theory of Integral Nursing, based in Nightingale’s Environmental Theory, the Honor Society of Nursing, Sigma Theta Tau International’s GAPFON (Global Advisory Panel on the Future of Nursing and Midwifery) support for United Nations Agenda 2030, and research demonstrating the value of the nurse in quality health care outcomes. Participation in state and regional health care reform initiatives, including advocacy for a nurse generalist role in the development and implementation of the New Mexico State Health System Innovation Plan (SHSIP), afforded project advocacy opportunities. The project sought to identify the risk to nursing and health care outcomes without a nurse generalist role in New Mexico’s reformed health care system, and the opportunity for nursing to re-imagine the nurse role in community based health care. The expected outcome of advocacy beyond the project is engagement of nurses in discussion and planning for a nurse generalist role in New Mexico’s community based systems of health care.