Doctor of Nursing Practice Projects

Permanent URI for this collection

https://ir.ua.edu/handle/123456789/7250
The DNP is a practice doctorate in nursing which prepares graduates to function at the highest level of nursing practice. The DNP curriculum includes development of a clinical practice project. This “DNP project” is designed to synthesize scholarship in an advanced nursing practice specialty or an area of health care leadership. Practice immersion experiences provide the context within which the project is completed. Students develop the project under the direction of a team, including program faculty, the student, the clinical advisor, the faculty advisor, and alumni mentors.

Browse

Browsing Doctor of Nursing Practice Projects by Author "Acker, Kristi"

Now showing 1 - 5 of 5
  • Thumbnail Image
    Item
    Evidence-based Opioid Guidance in Acute Care: An Initiative for Advocating Provider Stewardship
    (2021) Henderson, Jessica; Acker, Kristi; Shannon, Mary Ann; University of Alabama Tuscaloosa
    Introduction/Purpose: The purpose of this project was to improve providers’ knowledge and utilization of the Prescription Drug Monitoring Program (PDMP) and World Health Organization (WHO) pain ladder when prescribing opioid pain relievers in the inpatient setting. Methods: Fifteen providers, a mix of physicians and nurse practitioners, in the inpatient setting were recruited to participate in the project. The investigator provided one on one educational sessions regarding the utilization and importance of the PDMP and WHO pain ladder. Providers who have a Drug Enforcement Agency (DEA) license were eligible for participation while providers without a DEA license were excluded. Providers took a pre-test that measured providers’ perceptions on their knowledge regarding the PDMP and WHO pain ladder. Providers then received a brief online educational session regarding the importance of the PDMP and WHO pain ladder. Following the education sessions, providers were given six weeks to implement their knowledge regarding the utilization of the PDMP and WHO pain ladder into practice to see if it affects their prescribing behaviors of opioid pain relievers. After the six-week period, providers were sent a link to a post-education test that looked at their perception regarding knowledge gained during the project. Results: A total of 15 participants were recruited for the project at baseline. Ten providers completed the initial survey but failed to complete the pre and post-education surveys. Fifty percent (n=5) of the participants completed the project in full. The lack of participation is assumed to be due to the surge in COVID-19 cases when the project gained approval and began implementation. Of the five participants, three were nurse practitioners (60%) and two were physicians (40%). Data was analyzed by calculating pre and post test scores. The total score a participant could get was 90. The average score pre-education was 53 and the average score posteducation was 72. The project resulted in a 35% increase in knowledge. Discussion: This project implemented online education for providers regarding the PDMP/Narxcare™ and WHO pain ladder. The providers took a pre-education survey and posteducation survey. These surveys allowed providers to rate their knowledge of clinical practice guidelines, the PDMP/Narxcare™, and their assessment on whether or not they felt proficient in prescribing opioid pain relievers. The low provider participation rate was felt, in part, due to the unprecedented surge in community COVID-19 cases at the time of project implementation. Despite limitations and barriers, results showed providers perception regarding their knowledge of the PDMP, WHO pain ladder and opioid prescribing improved after six weeks. Additional studies with a large population are needed to determine if this education would benefit all providers and not just hospital-based ones.
  • Thumbnail Image
    Item
    Implementing a Checklist as an Inpatient Fall Prevention Intervention: A Quality Improvement Process
    Cameron, Tina; Acker, Kristi; Korrapati, Vijaya
    Introduction and Purpose: Older adults have a higher risk of acute setting falls, based on a multitude of factors, leading to prolonged lengths of stays and thousands of dollars in additional healthcare costs. The DNP project aimed to identify whether integrating a nurse-led Fall Prevention Checklist, alongside standard fall prevention interventions, reduces inpatient falls in older adults within a single oncology/medical-surgical inpatient setting. Methods: The project focused on decreasing falls in an inpatient setting over six weeks. Nurses were educated on the current clinical need for fall reduction, and “fall champions” were identified to help provide momentum in tool adoption. Moreover, the implementation strategy was evaluated, and nurse feedback was collected through a voluntary and anonymous post-implementation survey. Results: Nurses completed 663 Fall Prevention Checklists during shift changes. Fall rates between the implementation period and baseline rates were analyzed. The number of falls pre-implementation (6, n = 6) was significantly more significant than the number of falls post-implementation (2, n = 6), 𝜒2 (1, N = 12) = 6.00, p = .014; a decrease in the fall rate by 66.7%. Conclusion: The improvement in fall rates supports the idea that implementing a simple yet valuable tool, such as a Fall Prevention Checklist during shift change, can reduce fall rates. Only 4.5% of nurses provided feedback following the intervention, limiting nurse insight into the utility of the instrumentation. Based on the project limitations, findings should be viewed cautiously. However, the initial findings support that augment strategies, such as utilizing a Fall Prevention Checklist, can provide meaningful impacts on improving patient outcomes.
  • Thumbnail Image
    Item
    Integrating Oncology Nurse Navigation to Improve Care Transition
    Collins, Coretta; Acker, Kristi
    Oncology nurse navigation is recognized as a beneficial service in managing and caring for oncology patients. However, this service is not readily available in all settings including complex and high-risk units. This DNP Project aimed to integrate an Oncology Nurse Navigation program to measure the clinical outcomes related to the transition of care timeliness, improving hospital readmission rates and improving emergency department visits. Methods: Using a quality improvement process model, the advanced practice nurse led the integration of an oncology navigation service as part of an established oncology consulting service within a single site setting over six weeks. Patients newly diagnosed with cancer were provided purposeful care coordination and follow up. The coordination included the integration of an oncology nurse navigation tool and telecommunications as part of the program implementation process. Results: Pre and post-data were compared, and inferential statistics were reported. Descriptive statistics provided an optic of the patient population that benefited from the navigation services. The main practice outcomes were evaluated which showed interventional improvements in all three clinical outcome measures. Discussion: The project was well received by the institution and the stakeholders. The stakeholders recognized the benefit of integrating oncology nurse navigation to the team. The oncology consult team also recognized the benefit and found that it made the team function more efficiently. Based on the program's initial success, plans to keep the navigation program in place are expected. The value of intentional care coordination, including telecommunications, can improve transition of care delays and reduce overutilization of health care resources.
  • Thumbnail Image
    Item
    Providers’ Knowledge and Utility of Delayed Antibiotic Prescriptions in Primary Care
    Alsamah, Wasim; Acker, Kristi; Fritch, Robert; University of Alabama Tuscaloosa
    Introduction/Purpose: Unnecessary Antibiotic Prescription remains an ongoing problem for countries around the world, including United States. Most patients with acute respiratory infections(ARIs) do not benefit from antibiotic treatment. Köchling et al. (2018) explain that antibiotics do not provide any benefit to patients with ARIs,because the severity and duration of their condition do not change considerably. Researchers have evaluated many methods to lower the unnecessary useof antibiotics. One of the most successful methods was implementing delayed prescription (DAP). DAP is providing the patient with a prescription and a recommendation to fill out only if the initial symptoms worsen. However, many primary care providers are either unaware of DAP or reluctant to implement it. The purpose of this study is to increase providers’ knowledge of antibiotic resistance in the community and to determine the barriers of primary care providers to starting patients on DAP. Method: This quality improvement studywasconducted with a pretest-intervention-posttest strategy. A questionnaire was administered to participants to determine participants’ knowledge of and barriers to initiating DAP. Following the pretest, a 30-minute educational intervention waspresented on DAP, then providers were given one month to integrate the DAP program when applicable, followed by administration of the questionnaire as a posttest.The results of both questionnaires were compared with descriptive statistics and a paired-sample t test. Results: Paired t tests demonstrate that 6 items indicated significant improvements from pretest: providers’ view of DAP in reducing scheduled visits, inappropriate use of antibiotics, emergency visits, optimizing resources in clinic, providers’ knowledge about DAP, and changing patients’ perceptions to antibiotics. Further analysis revealed insignificant differences in 2 items; providers’ willingness to discuss DAP with their patients, and their readiness to initiate it. Discussion: Results were statistically significant for most of the questions involving providers’ perceptions on DAP effects on reducing scheduled visits, emergency visits, inappropriate antibiotic use, and the likelihood of provider’s willingness to include DAP in their practice. Implementation of this project should help primary care providers deliver necessary and timely care to adults presenting with ARIs.
  • Thumbnail Image
    Item
    Utilizing Palliative Care Principles to Improve Mood and Quality of Life in a Nursing Home: An APRN Initiative
    (2021) Fox, Michelle; Acker, Kristi; Tetrick, David; University of Alabama Tuscaloosa
    Purpose: The purpose of this DNP project was to implement nurse practitioner (NP) led palliative care (PC) services and to evaluate the practice change by measuring nursing home (NH) residents’ mood and quality of life (QOL). Methods: 20 patients residing in one NH in a single Midwestern state in the United States that met PC criteria (any chronic, serious illness) were included in the project. Patients received visits from a palliative/hospice trained NP once a week in addition to other facility services. Self-report measures of depression and QOL were administered at baseline and one month later. Repeated measures ANOVAs were performed to examine the change in mood and QOL over time. Results: 20 participants aged 44-88 years (average = 74.7 years, SD = 9.8 years) were enrolled, and 19 successfully completed four weeks of PC visits and questionnaires at baseline and four weeks. The average overall QOL z-score at the initial visit was -0.59 (SE=0.21) and average QOL z-score at the final visit remained -0.59 (SE=0.17). Results of repeated measures ANOVA showed no significant change in QOL score, F(1,18)=0.00, p=0.997, η2 p=0.00. Average PHQ-9 score at the initial visit was 9.90 (SE=1.11). At the final visit, average PHQ-9 score was 8.21 (SE=1.39). Repeated measures ANOVA showed no significant change in PHQ-9 score over time when examining the entire sample, F(1,18)=2.03, p=0.171, and the effect size was small, η2 p=0.101. However, when selecting for clinically significant depression symptoms (PHQ-9 score ³10) at baseline, there was a trend towards a decline in depression symptoms, F(1,10)=3.38, p=0.096, with a large effect size, η2 p=0.253. Though not statistically significant, the decline in depressive symptoms in this subset may be clinically meaningful. Conclusion: This project implemented PC focused visits with a NP in a single NH, with the goal of improving symptom burden, and focused on mood (PHQ-9) and QOL (MQOLexpanded). Despite limitations, results provide preliminary support for improvement in depressive symptoms among a subset of patients receiving PC services. Additional studies with a larger population are needed to determine if mood and QOL can be improved using PC services in the NH setting.