Scholarly Projects (DNP)
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This collection contains the scholarly projects students produced toward completion of their DNP degree.
All content in these collections is open to the public under the agreement stipulated in the non-exclusive distribution license signed by the student upon entering the program.
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Item Addressing Caregiver Burden Among Caregivers of Pediatric Renal Disease Patients(2023-08-07) Eze, Sochi; Connelly, Susan; Eze, SochiAbstract Purpose: The purpose of this project was to assess caregiver burden and subsequently determine strategies to improve caregiver burden for parents who are responsible for caring for a child who is either post kidney transplant or is receiving peritoneal dialysis or hemodialysis for kidney failure. Background: Caregivers of children on dialysis or post renal transplant have reported financial difficulties, social isolation, poor physical health, depression, disruption of family activities and relationships, and lower health related quality of life. Caregiver burden may negatively influence health outcomes of their children. Sample/Setting: Primary caregivers of a child with kidney failure post-transplant or receiving peritoneal or hemodialysis from at central Texas outpatient dialysis clinic. Method: Caregiver burden was determined by using the Pediatric Renal Caregiver Burden Scale (children receiving dialysis) and the Zarit Caregiver Burden Scale (children post-transplant). Semi-structured interviews were conducted during focus groups to determine themes regarding their existing burden as well as determine strategies to help lessen this burden. Result: 50% (6/12) of participants completed the caregiver burden scale (n=6 Caregiver Burden Scale). 8% (1/12) completed the Pediatric Renal Caregiver Burden Scale (n=1 Pediatric Renal Caregiver Burden Scale). The Caregiver Burden scale was high in all 5 domains (relationships, emotional well-being, social and family life, finances, and loss of control over one's life) for caregivers of children post renal transplant. The caregiver of a child on hemodialysis completed the Pediatric Renal Caregiver Burden Scale and scores indicated high burden as well. Identifying themes included emotional burden, coping strategies, lack of support, change in relationship, knowledge concerns and financial concerns. Conclusion: Caregivers of both pediatric patients on dialysis and pediatric post renal transplant patient reported high levels of burden which affects their process of caregiving. Healthcare personnel can help establish a more supportive atmosphere for caregivers thereby improving the overall quality of care for pediatric patients on dialysis and pediatric patients’ post-renal transplant. Keywords: caregiver burden, pediatric chronic kidney disease, Caregiver-reported outcomesItem Promoting Healthy Lifestyles in Pediatric Acute Lymphoblastic Leukemia Patients and Survivors Through Education: A Quality Improvement Project(2023-08-04) Clum, Jourdan; Connelly, Susan; Clum, JourdanAbstract Purpose: The purpose of this quality improvement project was to provide pediatric oncology patients who had recently completed acute lymphoblastic leukemia treatment or in the maintenance phase of treatment with literature to promote positive diet and exercise practices. Background: Acute lymphoblastic leukemia requires treatment that leads to long term comorbidities and sequelae. Poor diet and lack of exercise can contribute to cardiac and respiratory disease throughout a survivor’s lifetime. Sample/Setting: Acute lymphoblastic leukemia patients ages 5-18 in maintenance phase of treatment or survivors who have completed chemotherapy in an inpatient/outpatient pediatric hematology/oncology clinic in the Southeast. Methods: Pre/post survey design that assessed changes in diet and exercise habits after receiving verbal and written information regarding the benefits of healthy diet and exercise behaviors that would reduce the risk of secondary disease following cancer treatment. Results: No consistent changes in diet and exercise behaviors were noted during an eight-week timeframe following implementation of education materials and one on one counseling. Conclusion: Verbal and written information alone was not conducive to making sustainable changes in diet and exercise even for a short period of time. It appears more frequent, dynamic interactions are necessary to change behaviors in this pediatric ALL survivor population. Keywords: pediatric, cancer, oncology, nutrition, outpatient, exercise.Item Improving Colorectal Cancer Screening Rates among the Hmong Population in a Primary Care Clinic(2023-08) Vang, Kou; Carrico, Cathy; Vang, KouBackground: Cancer is the second leading cause of death in the U.S., following heart disease. Although Asian ethnic groups overall have some of the lowest CRC screening rates in the United States, the Hmong ethnic group have very low CRC screening rates. Methods: A quality improvement project was developed to increase CRC knowledge and increase screening rates among Hmong participants in a Minnesota primary care clinic. Collaboration with a Hmong community leader and the health system developed an educational video in the native language explaining the importance of CRC screening. Results: A total of 31 Hmong patients were identified as presenting for a well visit, with 10 patients in the targeted 65 or older age group. . Six patients were not current on CRC screening Two patients were offered the video, and watched by one patient, who did accept CRC screening. Discussion: A total of 33% of eligible Hmong patients were offered the educational video and had forms completed. It is unclear why this occurred, but several studies looked at negative healthcare outcomes as it relates to burnout, high patient volumes and inadequate staffing. Only one person watched the video and responded 4 out of 5 on all questions indicating they agree the video increased their knowledge and intent to get screened. Although the results were limited, the use of community leaders speaking in native language may increase the rate of CRC screening.Item Use of Newborn Screening ACTion (ACT) Sheets to Increase Referral of Patients with Hemoglobinopathy Trait for Genetic Counseling by Primary Care Providers(2023-07-31) Chance, Jillian A; Lappe, Joan M.; Chance, Jillian A.Background: Mandated newborn screening in the United States identifies infants with hemoglobin disorders and finds cases of heterozygous carriers of hemoglobin traits as a by-product of the screening. Problem: The lack of knowledge among hemoglobinopathy trait carriers provides concern. Most carriers do not know their status, and carrier couples are frequently unaware that they have a 25% chance with each pregnancy of having an infant with a hemoglobin disorder, such as sickle cell disease. Sickle cell trait (SCT) has the for potential rare health risks that should be shared with caregivers. Parental counseling is beneficial for the genetic parents and the infant due to the recessive inheritance pattern and is more effective when done by genetic counseling professionals. Primary care providers do not utilize genetic counseling services widely for infants identified with sickle cell trait identified via newborn screening. Purpose: This project aims to increase primary care provider awareness of genetic counseling services available for hemoglobinopathy traits and increase their use of genetic counselors to counsel and offer to test to parents of infants identified as carriers of hemoglobinopathy traits by the Nebraska Newborn Screening program. Determine if education increases the rate of referrals for genetic counseling. Methods: The primary outreach method to primary care providers (PCPs) was the "ACTion sheet” which provides direction and education to PCPs following a presumptive positive newborn screen. During a two-month period, the Nebraska Newborn Screening Program sent a modified ACTion sheet to PCPs which encouraged PCPs to refer these patients to an infant hemoglobinopathy clinic that includes genetic counseling. A 2 (provider specialty) x 2 (modified ACT sheet) generalized linear model with a binomial distribution and a logit link function was used to determine if the modified ACT sheet increased the rate of referral compared to prior to the modification. Main effects and interactions were considered significant if p < .05. All odds ratios are presented as 1:0. Results: Overall, half as many patients were referred to genetic counseling as were not referred (ORestimate = .50303), a ratio that was significantly different from 1, or an even distribution (z = -3.03, p = .002). There was a significant main effect related to the modified ACT sheet (χ2 = 6.60, p = .010). For those that did not receive the modified ACT sheet a referral to genetic counseling occurred only once for every five that were not referred (ORestimate = .204), however, for those providers who received the modified ACT sheet, the rate of referral to genetic counseling was four referrals for every five non-referrals (ORestimate = .828). The impact of messaging was dependent on provider specialty (χ2 = 4.00, p = .054). The new messaging improved the referral rate to genetic counseling for Family Medicine (FM) (ORestimate = 1.13; z = -2.19, p = .029). However, it did not significantly affect referrals among Pediatric providers with a -0.496 odds ratio compared to -0.78 (z = -0.570, p = .569) without messaging. Conclusion: Written messaging to PCPs encouraging referrals of infants identified with SCT for genetic counseling increases the likelihood of referral. The effect of messaging was stronger amongst FM providers than amongst Pediatric providers.Item Reducing Routine Overnight Vital Sign Monitoring on Stable Pediatric Patients(2023-08) Schneider, Karmyn; Hanks, Jacqueline; Schneider, KarmynProblem: Pediatric patients are enduring unnecessary sleep disturbances because of routine overnight vital sign monitoring. This population of patients are consistently getting less sleep than they need and are accustomed to getting at home, and sleep deprivation in children has been linked to multiple adverse health effects and unfavorable patient experience ratings. Purpose: The primary purpose of this evidence-based, quality improvement project is to increase the utilization of the “Q4 While Awake” vital sign order to reduce the frequency of vital sign monitoring interruptions overnight to facilitate longer spans of time for undisturbed sleep. Methods: The intervention will begin with educating both providers and bedside staff through an interactive learning module. The education will highlight the evidence that supports the project, the inclusion criteria and how to integrate this into the established workflow of the unit. The ordering providers should then begin using the “Q4 While Awake” order for vital sign frequency in stable patients. Visual placards will be placed on ordering providers' computers and at the nursing stations to remind everyone to advocate for a change in vital sign order when appropriate. Results: There were 238 patients that met criteria for the “Q4 While Awake” order in the preliminary data with only 1 having the order (0.42%). After implementation, 164 patients met criteria for the “Q4 While Awake” order and 37 (22.5%) had the order. 90% of assigned staff completed the learning module and there was no evidence of an increased risk of an adverse event or signs of care escalations in patients meeting inclusion criteria. Conclusion: It is safe to reduce routine monitoring in stable pediatric patients to allow for better sleep hygiene in the inpatient setting.