dnp thesis award

Outstanding PhD Dissertations and DNP Project Awards

AACN created this awards program to recognize and showcase outstanding dissertations and DNP projects completed by students in research- and practice-focused doctoral programs. Many doctoral students are advancing ground-breaking research and practice innovations that are worthy of national recognition and could serve as exemplars for other students to emulate.

Two awards will be presented each year, with one award presented in each of the following categories:

Excellence in Advancing Nursing Science Award for an outstanding dissertation from a student in a PhD in nursing (or DNS program). A dissertation is an original research project that focuses on advancing nursing science and developing new evidence with the potential to guide nursing practice. To apply, please fill out the online application .

Download PhD Nomination Information

Excellence in Advancing Nursing Practice Award for an outstanding final project from a student in a Doctor of Nursing Practice (DNP) program. A DNP project demonstrates high-level mastery of an area of advanced nursing practice and focuses on the translation of evidence into practice. To apply, please fill out the online application .

Download DNP Nomination Information

Nominations for these awards are due May 15, 2024.

Selection of Award Winners

A selection committee will review all complete nominations received and select award finalists. This committee reserves the right to decide not to recommend an award in any given year. Award finalists must be approved by the AACN Board of Directors.

Submission Process

Excellence in Advancing Nursing Science Award

Call for applications for this award is now open. To apply, please fill out the online application . The deadline is May 15, 2024.

Excellence in Advancing Nursing Practice Award

Award Presentation & Promotion

• The doctoral student/graduate receiving an award must attend AACN’s Doctoral Education Conference . The conference registration fee for the winners will be waived.
• The award will be presented by the AACN Chair at the start of conference.
• Award winners will present their abstracts on the second day of the Doctoral Education Conference.
• The award includes a “symbol” of appreciation and a $1,000 check. Winners will be announced via AACN publications and on its Website.

Past Award Recipients

2023 winners.

Background and Significance: Up to a million or more Americans live while traveling full-time in recreational vehicles (RVs). Many health policies are based on assumptions of stationary residency. Little study has been devoted to the healthcare experiences of Americans who are geographically mobile.

Purpose/Objective(s) and/or Specific Aims: The purpose of this study was to explore the experiences of RV-dwelling full-time American nomads when seeking healthcare in the U.S. and to identify barriers and facilitators of access to care. Levesque’s Conceptual Model of Access to Healthcare was used to generate questions for the interview guide. The principal investigator lived in an RV and traveled to a variety of campgrounds in several states to post recruitment  flyers.

Methods: The exploratory, qualitative design was informed by interpretive description. Interviews were recorded and transcribed verbatim. Thematic analysis was conducted with a phronetic iterative approach using Atlas.ti software.

Results/Findings: Participants included American adults who lived for more than six months of the year in an RV while traveling to different regions of the U.S. Participants were located in a variety of campgrounds in several states including Oregon, Wyoming, Colorado, New Mexico, Texas, and Arizona. Twenty-five RV-dwelling nomads participated in semi-structured interviews. Three overarching themes described the experiences of RVers: overwhelming logistics, don’t need healthcare, and orchestrating a web of care. Some of the barriers identified included difficulty vetting healthcare resources in unfamiliar locations, caregivers’ lack of understanding of the nomadic lifestyle, limited resources in rural areas, and rules limiting care and payment for care by state. Some of the facilitators identified included caregiver collaboration, telehealth, national chains with shared records, information and support from other RVers, and self-advocacy.

Conclusion(s): RV-dwelling nomads are an understudied population that face complexity and barriers to healthcare access related to seeking care in unfamiliar locations, misunderstandings about their lifestyle, and policies that prevent the portability of healthcare across state lines.

Background and Problem Statement: Adolescent mental health disorders are a growing public health issue globally. Though symptoms of mental health disorders were worsening before COVID-19, the pandemic exacerbated this crisis. Because adolescents spend most of their time in school, interventions focusing on mental health education and skill-building, reducing stigma, and increasing helping-seeking behaviors should be prioritized here. In a suburban Arizona school district, high school social workers and counselors are seeing increased social and emotional referrals and are looking for solutions. In 2021, the state of Arizona passed SB1376, mandating mental health education in public schools.

Purpose/Objective(s): This project aimed to evaluate the effectiveness of tMHFA (teen Mental Health First Aid) on high school students’ mental health literacy (MHL), mental health first-aid skills, and stigma perception. The project also qualitatively evaluated students’ opinions of tMHFA education and instruction. The implementation design included a phase two expansion and program sustainability by stakeholders within the existing district curriculum.

Procedures: Partnering with a large urban school district’s social work department, a teen Mental Health First Aid (tMHFA) pilot program was developed. Using the Iowa Model of Evidence-Based Practice (IMEBP) as a guide, the organizational priorities of teen mental health provided the trigger specific to this pilot project implementation. This model is fitting for working with a large public school organization and promoted expansion in the sustainability plan. tMHFA is a classroom-based mental health literacy and skill-building program for students aged 15-18 to promote mental health literacy, help-seeking behaviors, and attempts to reduce stigma while teaching adolescents to help a peer or friend through a mental health crisis. A "train the trainer" program was developed with key stakeholders (school district social workers) and the initial pilot project included eleventh-grade students who received three 90-minute classroom workshop sessions. The district chose one high school within the system for the pilot and provided class instruction time for the intervention. Parental consent and student assent were required to participate. tMHFA was delivered in three 90-minute classes on non-consecutive days. The initial pilot group included a class of nine (n = 9) adolescent students aged 17-18 years old. Using the Mental Health Literacy questionnaire (MHLq), a pre and post-test design was used to evaluate the program quantitatively and qualitatively. Descriptive statistics, two-tailed paired samples t-test, Shapiro-Wilk, and qualitative data were collected by student participants and project stakeholders.

Outcomes: Using the Mental Health Literacy questionnaire (MHLq), a pre and post-test design revealed a significant increase in the students’ mental health literacy, help-seeking behaviors, and decreased stigma (p<0.05). Students reported overall positive experiences based on a subjective question at the end of the survey. One student wrote, “I think all students should get a class like this.”  Project stakeholders will continue the tMHFA using project trained staff who are school district employed social workers to offer the program to all eleventh grade students in the project school. The district plans to expand the program to three additional schools in the next academic school year.  The tMHFA is now integrated into the district curriculum.

Conclusion(s): This pilot project using tMHFA significantly improved mental health literacy, mental health first-aid, and stigma perception. Students enjoyed and valued the programming, which is crucial when providing education to teenagers. The Iowa Model of Evidence-Based Practice provided implementation support to engage stakeholders, start the project with a small pilot, and develop a plan for expansion district-wide. After the original nine-student pilot, the district expanded to all junior-level students in one high school (800 students). It is now planning to deliver tMHFA to 2400 junior-level students in three of its high schools.

Background and Problem Statement: Unanticipated and adverse events are inevitable in healthcare. Second victim phenomenon (SVP), which happens when a clinician experiences personal or professional negative effects after a clinical event, can impact the psychological and physical health of the clinician and compromise subsequent care. One in five UTMB Department of Anesthesiology clinicians surveyed reported experiencing an emotionally distressing clinical event in the preceding 30 days. An alarming 88% knew of a colleague emotionally affected by a work event; only 20% felt these individuals had been adequately supported. Prior to the DNP project, no formal process was in place to facilitate peer support.

Purpose/Objective(s): This project served to implement evidence-informed strategies for emotional peer support and foster clinician resilience within the department of anesthesiology. A needs assessment survey indicated that over 90% of clinicians would likely look to a trusted colleague for support after an emotionally challenging clinical event. The project aim was that at least five UTMB Health Anesthesiology clinicians would participate in the emotional peer support process each week between September 26 – December 19, 2022.

Procedures: A diverse group of peer-nominated clinicians, led by the DNP project coordinator, completed specialized training to learn formal peer support. The pilot team, forU Peer Support, comprised all levels of anesthesia professionals, including physicians, APRNs, and residents. Trained peer supporters (TPS) collected de-identified information from interactions, including the precipitating event, provider type, and satisfaction. Encounter forms included an area for open-ended feedback for ideas to help improve the process, such as adding a badge-buddy with additional identification and tips. The department webmaster and project lead collaborated to add a Peer Support Resource hub to the intranet. Resources, including SVP awareness, coping strategies, emotional first-aid tips, a team roster, and professional mental health services contacts, were made available for 24-7 access. The project was promoted via multiple channels including grand rounds, email communications, and the use of branded badges and brochures. The proactive process included a standardized outreach email from forU to any provider involved with an internal morbidity and mortality (M&M) report. Data were collected and analyzed using a multi-pronged approach via surveys, training evaluations, website analytics, and encounter forms. The project coordinator followed encounter forms and monitored participation using a run chart which included the frequency of encounters and intranet resource access. The continuous quality improvement process utilized a rapid cycle Plan-Do-Study-Act (PDSA) approach to determine whether changes and additional interventions were necessary to achieve the project aim.

Outcomes: Fifteen percent of anesthesia providers at UTMB Health completed the formal training and continue to serve as support champions. Over three months, supporters recorded 33 encounters, with an average satisfaction rate of 4.76/5 stars. The intranet site, intended to destigmatize mental health resources and normalize SVP, was accessed over 100 times with high ratings. Before implementation, only 21% of clinicians agreed that adequate and timely emotional peer support resources were available, and post-implementation agreement increased to 77%. Many incidents warranting support were related to patient care and adverse events, but some were related to individual issues, such as work-life balance and workplace bullying. Survey results showed that awareness of the term second victim (advocated as the primary intervention in mitigating its negative effects) doubled. The project continues to have a strong team champion presence, with 25 clinicians being trained and identifiable by branded badges in the clinical setting.

Conclusion(s): This DNP-driven project was a leap forward in safeguarding clinician well-being and efforts have shown to be impactful and meaningful to clinicians. The project was collaborative and inclusive and used translational methods to improve outcomes for the healthcare team and enhance patient safety. While the incidence of challenging clinical events remain constant, the forU program models strategies to encourage substantial improvements in levels of perceived support. A thriving workforce is a necessary prerequisite to advancing patient safety and care, and the forU program helps ensure a culture of care that puts workforce well-being as a high priority.

2022 Winners

Background and Significance: Postoperative pulmonary complications (PPCs) are associated with high rates of mortality and morbidity, intensive care admission, hospital length of stay, and resource utilization. PPCs are attributable to both modifiable and non-modifiable risk factors associated with characteristics of patients, surgery, and anesthesia. Although many PPC risks are not modifiable, intraoperative ventilation parameters can be adjusted to reduce risk. Lung protective ventilation (LPV) has been adapted for intraoperative use to protect pulmonary parenchyma against ventilator-induced lung injury (VILI). Questions remain regarding “how”, “when”, and for “whom” LPV can be used to minimize VILI leading to PPCs.

Purpose/Objective(s) and/or Specific Aims: The overarching goal of the dissertation was to identify personalized care strategies that optimize ventilation parameters in order to reduce PPCs for adult patients undergoing a non-cardiothoracic non-obstetric surgery with general anesthesia and mechanical ventilation. The specific aims were to identify: (Aim 1) phenotypes based on preoperative patient and surgical nonmodifiable risk factors to understand the risk of PPC; and (Aim 2) optimal intraoperative ventilator parameters associated with the most desirable outcome for each phenotype.

Methods: A retrospective cohort observational study leveraging electronic health records (EHRs) was conducted. The study included 34,910 adult surgical patients (≥ 18 years of age) who underwent general anesthesia with mechanical ventilation for non-cardiothoracic non-obstetric procedures between 1/1/2018 and 8/31/2019 at a health system in the Southeast of the United States. The PPC outcome in this study was composed of two properties: PPC diagnosis and postoperative respiratory status (PRS) severity. The International Classification of Disease, Tenth Revision diagnosis codes (e.g., acute respiratory distress syndrome, pneumonia) were used to identify patients who developed PPCs. PRS severity was rated by the level of postoperative requirement for supplemental oxygen and ventilatory support.

For Aim 1, the least absolute shrinkage and selection operator (LASSO) regression was first employed to select variables. Then, the classification and regression tree (CART) was conducted for PPC diagnosis and PRS severity to identify phenotypes. For Aim 2, the stratified logistic regression of PPC diagnosis and multinomial logistic regressions of PRS severity with stepwise selection and forced inclusion of tidal volume (VT) and positive end expiratory pressure (PEEP) were performed within each phenotype. The area under the receiver operating characteristic curve was computed to identify the optimal values of VT and PEEP.

Results/Findings: CART identified 14 subgroups for PPC diagnosis (Phenotype 0 though 6) and PRS severity (Phenotype A thought G). The optimal PEEP and VT values ranged from 4 to 12 cmH2O and from 5.98 to 9.39 ml/kg predicted body weight across phenotypes, respectively. The parameters for Phenotype 0, which associated with the lowest PPC incidence (3.9%), 6.25 ml/kg and 5 cmH2O. Phenotype 5 had the highest likelihood of developing PPCs (71.4%), and their optimal parameters were 7.35 ml/kg and 5 cmH2O. Phenotypes A and C had the highest likelihood of having the most severe PRS level; the optimal parameters for Phenotype A were identified as 7.44 ml/kg and 6 cmH2O, and those for Phenotype C were 7.73 ml/kg and 6 cmH2O. In contrast, Phenotype E was associated with the lowest likelihood (3.3%) of having the most severe PRS, and the optimal parameters were 5.98 ml/kg and PEEP of 8 cmH2O.

Conclusion(s): This dissertation was the first to use CART to classify phenotypic subgroups based on risks for PPCs and classified the adult surgical patients into 14 phenotypes based on non-modifiable preoperative risks. The intraoperative mechanical ventilator parameters should be adjusted based on a patient phenotype to optimize the postoperative outcomes. This dissertation (a) offered a foundation for individualized care to optimize patients’ outcomes, and (b) identified several directions for future research to advance our understanding of care individualization aimed at reducing incidence of PPCs and alleviating PRS severity.

Background and Problem Statement: Patients older than age 65 seeking UCSF Health Emergency Department (ED) services represent 32-34% of total visits, contrasting the 20% national average. Published return to care data in this population (recidivism) at 30 days accounts for 6-28% of visits. Addressing medication management challenges, in real-time, can impact self-efficacy and recidivism during ED medication reconciliation thus improving the patient experience. Contributing to the challenge was 50% of older adults reporting medication non-adherence. As part of the institutional motivation California state law SB1254 required hospitals to complete medication reconciliation for all high-risk patients at any point in the continuum of care. The emergency department, as portal of entry to the health system, was a logical starting point. Published patient awareness of their plan of care, after discharge, across 4 domains varies from 24-64%.

Purpose/Objective(s):  The aim of the project was to determine the impact of a structured medication reconciliation workflow on older adult medication self-efficacy as the primary outcome. As secondary outcomes, recidivism, and awareness of plan of care in the Emergency Department were also examined during data collection for a concordant period. As part of an evidenced-based study there is value in collecting qualitative data regarding interprofessional stakeholder experience. Post study lessons-learned was an opportunity for professional participants to share their insights.

Procedures:  Following a pilot of the Medication Management Deficiencies in the Elderly (MedMalDE) a modified version was utilized during medication reconciliation. This was a convenience sample of 21 older adult patients assessed over four contiguous weeks in an academic 35-bed emergency department (ED) with 10 additional observation beds. Concurrently the Self-Efficacy for Appropriate Medication Use (SEAMS) confidence survey instrument was used as the outcome instrument applied prior to medication history or reconciliation in coordination with the pharmacy technicians. Additionally, 164 patients were assessed with only the MedMalDE over the same period without self-efficacy measurement due to a variety of factors. All patients were age 65 or older and primarily responsible for their medication management in this pre- and post- design. Primary language was not a barrier with video translation services at the bedside. Reconciliation interventions occurred at the index ED visit and the SEAMS was repeated via telephone at seven to fourteen days following their return to home whether discharged from the ED or post-hospitalization. A secondary outcome measure included a survey of 56 patient’s awareness of ED plan of care collected concurrently and during a pre-intervention period for comparison. Aggregate 30-day recidivism for study patients was another secondary outcome. It was assessed at 39 days prior to, during, and after the pre/post intervention to match the SEAMS four-week data collection and 7–14-day follow-up periods.  Descriptive, Wilcoxon Signed Rank, and Mann-Whitney U Tests were used for statistical analysis where appropriate.

Outcomes: Descriptive statistics revealed patient demographics were similar for intervention and aggregate ED patients. Mean SEAMS scores were significantly improved following MedMalDE guided interventions using the Wilcoxon Signed Rank Test (Z=-2.6989, p=.0077). 30-day ED recidivism for intervention patients was 9.5% versus aggregate patients at 12.3% but not significantly different using Mann Whitney U. The qualitative data from 7-14-day SEAMS follow-up highlight the continued gaps in health system support for the post-discharge experience. The thematic qualitative findings from interviewing the Department of Pharmacy professionals highlighted their satisfaction with improvement study, insights into common medication self-management challenges, and value of caregiver participation.

Conclusion(s): A structured medication reconciliation for older adult ED patients can be incorporated in standard pharmacy workflows, identify common medication challenges addressed in real time, and improve self-efficacy. The qualitative findings collected during the post SEAMS telephone follow-up revealed the lack of uniformity of post-discharge problem-solving with patients and caregivers despite existing professional discharge support. Health systems need to adopt best practices to mitigate health care return to care by addressing gaps in the plan of care communication, assessment of functional, access, and knowledge deficits in medication management, and ensure patient discharge transitions are better supported.

2021 Winners

Raymond Romano, III, PhD University of Tennessee Health Science Center Early Diagnosis of Alzheimer's Disease in the Primary Care Setting Program Director - Carolyn Graff

Purpose/Objective(s) and/or Specific Aims: The overall aims of this program of research were to understand factors contributing to AD diagnosis variability in primary care practice settings and to find ways to improve early AD diagnosis by primary care providers. Four projects were undertaken to meet the aims and each resulted in a published manuscript.

Methods: Four studies were undertaken to achieve the aims. The first study reported the results of an integrated review estimating the prevalence of missed diagnosis in primary care when compared to trained raters’ diagnoses. The findings call to attention the difficulty primary care providers face to detect and diagnose AD at all levels of the healthcare system.

In order to understand the pain experience in those with worsening cognition, the second study was a secondary analysis of a cross-sectional age- and sex-matched two group cohort study and found that the experience of pain differs between males and females as a measure of cognition worsened suggesting a possible role of pain as a tool to distinguish those at risk for AD.

This finding led to the third study, which was a narrative review conducted to describe how alterations in senses have been associated with the diagnosis of AD. The results suggested differences in smell, taste, vision, hearing, and proprioception were associated with different levels of the AD continuum but points out an obvious gap in the literature concerning other senses. This led to the fourth study examining evidence that the e4 allele of Apolipoprotein E modifies the experience of pain in those individuals carrying the allele such that greater temperatures are required to elicit pain and the experience of that pain is more unpleasant.

Results/Findings: The first published manuscript, an integrative review, highlights the complexity of barriers that exist at each level of the health care system contributing to limit diagnoses of AD by PCPs. One study suggested that the complexity of the patients’ presenting problems makes it difficult to diagnose AD. The results of the second study demonstrate that the experience of pain, a common comorbidity seen in AD, differs between males and females as a measure of cognition worsens suggesting pain may be a useful marker of AD. The third study, a narrative review demonstrates differences in senses have been associated with the different diagnostic categories of AD.The fourth study found individuals at increased risk of AD experience pain based on their APOE4 status at a greater temperature and found that pain was more unpleasant when compared to those without the increased risk of AD.

Conclusion(s): The search to identify non invasive preclinical markers of AD would allow for earlier interventions and the potential use of disease modifying medications once approved in the primary care setting. Older adults and their loved ones often seek care from their primary care providers with initial concerns for memory. However, primary care providers’ diagnostic accuracy is poor and it takes about 17 years for research to catch up to in clinical practice (“2020 Alzheimer’s disease facts and figures” 2020). The evidence of this research suggests pain as a possible early marker of AD.

Bridget A. Chandler, DNP University of Washington Case Study: Seattle Public Schools' (SPS) 2019-20 Immunization Campaign to Protect Health and Prevent School Exclusion Program Director - Tatiana Sadak

Purpose/Objective(s):

• Develop and disseminate a nurse survey on use frequency and effectiveness of campaign tools, capture nurse expert opinion, and glean insight for improvements.
• Characterize nurse ratings of tools and strategies, summarize observations of campaign and risk factors for non-adherence, and summarize insights for improvement.
• Create a demographic and immunization database for two years following state vaccine law implementation.
• Analyze student data, using descriptive statistics and tests for differences.
• Characterize differences in non-adherence compared to all students and describe traits that may predispose students to non-adherence.
• Recommend improvements to protect health and prevent school exclusion.
• Disseminate findings to support vaccination efforts.

Procedures: The Knowledge To Action and Phenomenological frameworks guided evaluation of the SPS 2019-20 immunization campaign. Since this campaign was conducted primarily by school nurses as end-users, their voices are needed to improve ongoing immunization efforts. The Phenomenological framework guided the search for nurses’ meaning about the campaign. Project objectives were met through the following process:

• Problem Identification: Impetus was SPS’ desire to evaluate the immunization compliance campaign, seek nurses’ wisdom, analyze non-adherent cohorts for inequity-driven barriers, inform future SPS improvements, and share findings with the broader community.
• Reviewed literature and studied 17 articles and RCTs
• Catalogued tools and strategies used in the SPS campaign
• Created Excel database of de-identified SPS demographic and Washington State Immunization Information System (WAIIS) immunization data for all non-adherent students
• Sought guidance and expert opinion from local, state, and national vaccine experts
• Surveyed SPS nurses about tool use/effectiveness and observed risk factors for non-adherence. Open narrative option captured anything nurses wished to convey. 
• Analyzed and characterized qualitative nurse survey data with REDCap
• District-wide data were compared with non-adherent student data before and after 2019 laws.
• Data: gender, grade, ethnicity, primary/home language, birth country, English language learner, disability, advanced learner, Running Start, foster, homeless, immigrant, equity tier, and adherence for DTaP, Tdap, Polio, HepB, MMR, and Varicella.
• Created and disseminated communication tools collaboratively with SPS

Outcomes: School Nurse Survey (60% response rate): Most frequent strategies: nurse outreach (families, students, providers). Most effective strategies: Head Start collaboration, conversations with families, Instructional Assistant outreach. Risk factors for non-adherence: family beliefs, low/high incomes, non-English home language, person of color, immigrant, homeless, distrusting health care. Non-adherence often result of barriers to access.

Student Data: Non-adherence decreased across time for all groups. Traits significant for non-adherence: Grade Level, immigrant, English Language Learner, Homeless, Ethnicity, Primary/home language, Equity Tier. Hispanic, African American/Black, and Native Hawaiian/Pacific Islander students not coming into adherence as quickly as White, Asian, Multiracial, and Alaska Native/Native American peers.

Conclusion(s): Practice inquiry shows nurses employed evidence-based practices to reach 97% immunization adherence. A variety of tools were used in a strategy of tailored outreach with increased intensity to prevent school exclusion. Nurse perceptions of risk factors for non-adherence were supported by data. Nurses express concern that enforcing laws requiring adherence to remain in school may have damaged relationships with students and families. Data support that many non-adherent students come from communities with historic and current experiences justifying distrust in health care systems. Non-adherence may be more a result of barriers to access than negative beliefs about vaccines.

2020 Winners

Jewel Scott, PhD, MSN Duke University Social Contributors to the Cardiovascular Health of Young Adult Black Females Program Director - Sharron Docherty

Background and Significance: Black females experience disparate rates of hypertension and earlier decline in cardiovascular health (CVH) than other females in the U.S. Most research on CVH in Black women has focused on deficit models of middle and older adults’ CVH behaviors as compared to women from other racial/ethnic groups. This approach has significantly limited our understanding of lifelong social exposures on Black women’s CVH. Importantly, few studies have examined how early life stress and social adversity contribute to premature decline in CVH, strengths that buffer against them, or within-group variations in exposures and outcomes to contextualize Black women’s CVH to mitigate disparities.

Purpose/Objective(s) and/or Specific Aims: The purpose of this dissertation was to fill a critical gap in Black women’s CVH research and refocus the field on earlier mitigation and strengths-based approaches. The aims were to: (1) examine the contribution of social contexts including adverse childhood experiences (ACEs) and racism, to the CVH of young adult Black women: and (2) determine the extent to which positive social determinants (e.g. spirituality, maternal relationship) in adolescence and young adulthood may promote CVH.

Methods: This study was a descriptive, secondary analysis of data from Black females who participated in the National Longitudinal Study of Adolescent to Adult Health (Add Health). A population representative sample of adolescents were enrolled in 1994 and followed prospectively with periodic, in-person data collection, and cardiovascular data was obtained in 2006 when the cohort were ages 24-32. The outcome for the first analysis was hypertension status and the outcome for the 2nd and 3rd analyses was ideal CVH, a summed score created by the American Heart Association consisting of self-reported health behaviors (e.g., smoking, diet) and objectively measured cardiovascular-associated biomarkers (e.g., glucose, cholesterol) that correlate with cardiovascular outcomes (e.g. myocardial infarction). All analyses were conducted using sampling weights to account for the complex survey design.

Analysis 1 was conducted with the publicly available data and used multivariable logistic regression to determine whether self-reported social adversities (social isolation, discrimination, perceived stress, subjective social status, child abuse) and sleep characteristics (delayed sleep onset, frequent awakening, short sleep, long sleep, and snoring) increased risk for hypertension. Analysis 2 used latent class analysis to examine patterns of social adversities (listed above plus food insecurity, housing insecurity, witnessing violence, victimization) on ideal CVH overall and for subgroups. Analyses 3 used principal components analysis to develop positive SDOH subscale scores (maternal relationship, spirituality) during adolescence and young adulthood. Multivariable regression was used to examine the influence of positive SDOH during adolescence and young adulthood, severity of ACEs, and their interactions on ideal CVH at young adulthood.

Results/Findings: In the first analysis (N=608), discrimination and frequent awakening were associated with higher odds of hypertension. The second analysis (N=1318) revealed three latent classes: low stress, high violence, and high stress. Although subclasses did not predict overall CVH, Black women who experienced high stress had a higher probability of being physically active and normotensive, while those with low stress had a higher probability of meeting dietary goals. The final analysis (N =1203) determined that greater spirituality in adolescence or young adulthood may promote CVH, but its influence diminished after accounting for factors such as mental health. The interaction of ACEs and spirituality showed that greater spirituality in adolescence or young adulthood buffered CVH regardless of ACEs level. Maternal relationship did not significantly predict CVH, but the interaction of ACEs and maternal relationship in young adulthood showed that ACEs scores were associated with worse CVH when the maternal relationship was stronger.

Conclusion: This study may be the first to explore CVH using a strengths-based approach and data from a within-group, population-representative sample of young adult Black women. Findings suggest that there are critical differences in how social contributors influence health, and, while many social constructs analyzed had little influence on health, they may not accurately reflect the underlying construct for different subpopulations. Importantly, there likely are other social factors that affect the health of Black women that are not well-captured in existing scientific research (e.g., frequency/type of microaggressions, racial identity, social connections) and require further research to advance CVH equity.

Team Award (Names listed below) Uniformed Services University of the Health Sciences Battlefield Acupuncture in the Management of Non-Traumatic Low Back Pain in Service Members Program Director - Heather Johnson

Background and Problem Statement: Low back pain (LBP) among US active-duty service members (ADSMs) is a leading cause of permanent disability in the Army (Rhon & Fritz, 2015). The extraordinary pace of work, deployment cycles combined with heavy equipment operations, airborne maneuvers, and extensive physical demands increase the likelihood that ADSMs will incur lower back pain and injury (Roy, Fish, Lopez, & Piva, 2014; Armed Forces Health Surveillance Center [AFHSC], 2010). The high prevalence of LBP in ADSMs places significant burden on the overall strength and capability of the force. Battlefield Acupuncture (BFA), a form of auricular acupuncture, is a safe, effective, non-pharmacologic treatment for LBP and aligns with Department of Veteran’s Affairs (VA)/Department of Defense (DoD) Clinical Practice Guideline (CPG) recommendations. However, recent literature reveals numerous provider reported barriers such as lack of knowledge and training which pointedly limits the use of effective BFA treatments.

Purpose/Objective: The purpose of this DNP Team project was to increase provider knowledge of VA/DoD guidelines for the BFA treatment of LBP, and to mitigate perceived barriers to offering BFA in the primary care setting. The main objective of this project was to increase BFA intervention rates and explore patient self-reports of treatment effectiveness, as well as examine numbers of pain medication prescriptions, and duty-limiting profiles (activity restrictions) that impact individual Soldier readiness.

Procedures: A team of five Doctor of Nursing Practice family nurse practitioner students conducted an evidence-based practice project to increase use of BFA with ADSMs presenting with LBP at two large Army installations in North Carolina and in Texas. Using Rosswurm and Larrabee’s Model for Evidence-Based Practice Change (1999) as the organizing framework, a multifaceted program of BFA in the treatment of non-traumatic LBP was presented to primary care providers. Providers received a 30-minute in-service to review the 2017 VA/DoD LBP CPG, followed by a knowledge questionnaire related to BFA utilization perceived barriers related to use with LBP in the clinic. A retrospective record review was conducted for a three month timeframe to analyze rates of BFA being offered and administered, central nervous system (CNS) depressant medication prescriptions, and activity limiting temporary and permanent LBP profiles using ICD-10 diagnosis code M54.5 (low back pain). The DNP Team designed, operationalized and evaluated two supervised BFA walk-in clinics for 8 full weeks. Patient demographic data, and pre and post pain ratings using the Defense and Veterans Pain Rating Scale (DVPRS) were collected on all patients who accessed the walk-in BFA clinic.

Outcomes: Nearly all providers were trained and certified in BFA in two walk-in clinics, resulting in 231 patient encounters. At Ft Bragg, BFA treatments increased 212% with 82% of patients reporting immediate pain relief (2.1 reduction on 10-point scale). Patients were 93% less likely to obtain a new profile, 44% less likely to have a pre-existing profile, and 46% less likely to be prescribed a CNS depressant. Patients at Fort Hood saw 1.9 point decrease in pain with 43% reporting relief. They were also 30% less likely to obtain a new profile and 52% less likely to have a pre-existing profile.

Conclusion: The pervasiveness of LBP among ADSMs imposes substantial burden on military readiness. DNP Team project data suggests BFA is an effective, safe treatment for LBP. Increasing rates of BFA as a non-pharmacologic integrative therapy for LBP may improve soldier readiness in the form of decreased pain, fewer CNS depressant medication prescriptions, and fewer activity limiting profiles.

Background and Problem Statement: Mechanical ventilation (MV) is commonly used to support breathing and pulmonary gas exchange in critically ill patients who experience respiratory failure. More than 1/3 of intensive care unit (ICU) patients in the United States require MV (CDC, 2018). Aging patients with multiple comorbidities and hospital-acquired complications are at high risk of requiring prolonged MV. Prolonged MV puts patients at risk for MV associated complications such as barotrauma, diaphragmatic muscle atrophy, pneumonia, decreased cardiac output, and muscle weakness, and can increase the ICU and hospital length of stay (LOS), as well as mortality (CDC, 2018; Devlin et al, 2006; Wang et al, 2013). Paired spontaneous awakening trial (SAT) and spontaneous breathing trial (SBT) can significantly reduce the duration of MV and ICU LOS (Marelich et al., 2000; Roh et al., 2012; Dankers et al., 2013). Studies show that a nurse-driven SAT and SBT can have a positive impact on ventilator-associated outcomes.

Purpose/Objective: The purpose of this evidence-based (EBP) quality improvement project was to decrease the duration MV by implementing a registered nurse (RN) and respiratory therapist (RT) driven SAT and SBT protocol with intubated adults in a general ICU. Prior to the project, providers (MDs) used no standardized protocol to evaluate patient readiness for liberation from MV.

Procedures: This project was implemented in a16-bed medical-surgical ICU in a community hospital in a medium sized midwestern city. All stable adults (except cardiac surgery patients) undergoing MV were screened daily for participation. A patient safety screen was used to determine whether the SAT and SBT could be initiated by the RN and RT. Additional safety criteria were used by the RN and RT to determine whether the SAT or SBT should be stopped due to patient intolerance.

Duration of MV (hours), ICU LOS (hours), and number of 24-hour failed extubations (24hrFE) were measured to compare outcomes before implementation to post implementation. Measures of staff self-reported confidence in performing the SAT and SBT, and evidence of staff protocol adherence, from the electronic health record, were also recorded.

Evaluation goals were established prior to implementation. A goal of 15 % improvement was set for both duration of MV and ICU LOS. For 24hrFE the goal was no increase in 24hrFE. This outcome was included to determine if any reduction in duration of MV was associated with an increased need for re-intubation. The goal for staff self-reported confidence in protocol implementation was set as an improvement on a 1 – 5 scale. The goal for staff adherence with daily performance of the SAT and SBT protocol was set at 50 %. Implementation of the project began July 1, 2019 and was completed November 1, 2019.

Outcomes: Duration of MV decreased by 27 hours (38.6%) (Wilcoxon Rank-Sum Test, p=0.000802). ICU LOS decreased by 32 hours (27.9%) (Wilcoxon Rank-Sum Test, p=0.01248). 24-hour failed extubations decreased from 4 to 2 (Fischer’s Exact test, p=0.419). Pre- and post-survey of staff confidence utilizing the protocol yielded a 20% increase in confidence. Staff adherance with SAT and SBT protocol, measured using EMR data, revealed initial RN and RT adherance was 49% but increased to 90 % at the end of the project. Provider adherence to writing protocol orders increased from 70 % to 90 %. All project goals were met.

Conclusion: This project demonstrated the feasibility and positive impacts of implementing an RN and RT-driven MV liberation protocol in a community hospital ICU. Patient outcomes associated with MV were improved. Incidental findings support additional impact of this project. Sedation scores on the Richmond Agitation and Sedation Scale rose from -3 (moderately sedated) to -2 (lightly sedated) and hospital LOS decreased from 243 hours to 204 hours (1.65 days). Successfully improving patient outcomes and increasing staff confidence in use of the protocol also supports RN and RT autonomy, thereby advancing the impact of their professional contributions.

2019 Winners

Marliese Nist, PhD, RNC The Ohio State University Inflammatory Mediators of Stress Exposure and Neurodevelopment in Very Preterm Infants Program Director - Rita Pickler

Background and Significance: Preterm infants experience chronic stress exposure during their extended hospitalization in the neonatal intensive care unit as a result of the medical procedures and nursing care required for their survival. The Neonatal Stress Embedding (NSE) Model theorizes that chronic stress exposure affects multiple biological systems in preterm infants, including functioning of the immune system, autonomic nervous system, and hypothalamic-pituitary-adrenal axis and causes changes in gene expression that result in abnormal brain development and neurodevelopmental impairments. Specifically, the NSE Model posits that chronic stress exposure causes systemic inflammation that damages the immature brain. Purpose/Objective(s) and/or Specific Aims: The specific aims were to (1) determine the relationships among stress exposure, inflammation, and neurodevelopment in very preterm infants and determine the mediated effect of inflammation on the relationship between stress exposure and neurodevelopment, (2) describe cytokine trajectories in the weeks following birth and determine the effect of stress exposure on these trajectories, and (3) examine the relationship between chronic stress responses and stress exposure in preterm infants. Methods: This was a non-experimental, repeated measures study of very preterm infants born between 28-31 weeks post-menstrual age (PMA). Infants were enrolled from four neonatal intensive care units in a large Midwest metropolitan area. The Institutional Review Board approved the study, and mothers of eligible infants provided written informed consent prior to the initiation of any study procedures. Cumulative stress exposure was measured using the Neonatal Infant Stressor Scale (NISS) over the first 14 days of life. The NISS provides a count of acute (e.g. intubation, lab draw) and chronic (e.g. mechanical ventilation, sepsis) stressors that is weighted by stressor intensity. Data to complete the NISS were retroactively extracted from the electronic health record. Blood was collected weekly with a clinically-indicated lab draw until 35 weeks PMA to measure inflammation. Inflammation was operationalized as a panel of cytokines and chemokines, quantified by multiplex assay. Average levels of individual cytokines/chemokines and average composite z-scores that included all detectable cytokines/chemokines were used. Neurodevelopment was assessed at 35 weeks PMA using the cluster scores for motor development and vigor (MDV) and alertness/orientation (AO) from the Neurobehavioral Assessment of the Preterm Infant. Hair for the measurement of hair cortisol concentration was collected by shaving at the nape of the infant’s neck at 35 weeks PMA. Multiple linear regression models, conditional process analysis, and linear mixed models were used to analyze the data. Statistical models included interactions with PMA at birth and infant sex and controlled for overall illness acuity. Results/Findings: Seventy-three infants were enrolled in the study. We quantified plasma interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), monocyte chemoattractant protein-1 (MCP-1), IL-8, and IL-1 receptor antagonist (RA) but were unable to measure IL-1β, IL-4, IL-10, and IL-17 in the majority of plasma samples. Although stress exposure did not significantly predict neurodevelopment, some measures of inflammation predicted MDV and AO. TNF-α and IL-1RA were associated with MDV scores. Composite scores of inflammation (i.e. average composite z-scores) were associated with MDV and AO scores. There were significant interactions with PMA and infant sex. In the mediation models, only IL-1RA mediated the effect of stress exposure on neurodevelopment. Linear mixed models revealed significant trends in postnatal cytokines/chemokines that were not affected by stress exposure. Cumulative NISS scores, a measures of stress exposure, did not correlate with hair cortisol concentrations, a measure of chronic stress responses. Conclusion: While we could not confirm a relationship between stress exposure and neurodevelopment, inflammation may be an important predictor of short-term neurodevelopment. IL-1RA is an important cytokine for studies of preterm infant neurodevelopment. Moreover, composite z-scores may be a better measure of inflammation than individual cytokines/chemokines. Inflammation can be damaging to the immature brain and is a potential mechanism through which early life stress affects long-term outcomes. Stress does not appear to affect cytokine/chemokine trajectories. Cytokine/chemokine levels, most of which decrease over time, may be developmentally regulated or the result of resolving inflammation following preterm birth.

Background and Problem Statement: The prevalence of both type 1 and type 2 diabetes are increasing in the pediatric population (Alberti et al., 2004). In addition to milestones that accompany normal growth and development, children diagnosed with diabetes incur an additional set of challenges, physiologically as well as psychologically. Among youth with diabetes, death is more likely to occur due to an acute complication, such as DKA or hypoglycemia (Saydah et al., 2012). According to a report generated from Epic, the University of Mississippi Medical Center (UMMC) electronic health record, from November 2014 to November 2015 there were 195 hospital encounters including the ICD-10 code for DKA (this includes ER visits and hospital admissions), 141 of which resulted in hospital admissions. Of these 195 encounters, approximately 40% were repeat admissions (University of Mississippi Medical Center, 2019). Purpose/Objective: The purpose of this scholarly project was to determine the effect of the telehealth RPM system initiative on HbA1c and diabetes-related ER visits and hospital admissions in the pediatric diabetes population at UMMC. The goal of the RPM program was to reduce HbA1c levels, to prevent unnecessary hospital encounters, and to allow the provider to make insulin adjustments between visits, as the pediatric population requires frequent insulin adjustments during periods of growth. Procedures: UMMC Center for Telehealth, in collaboration with Children’s of Mississippi, Division of Pediatric Endocrinology, began to enroll pediatric patients with type 1 and type 2 diabetes into an RPM (remote patient monitoring) program in November of 2015. Patients receive a blue-tooth glucose meter and an iPad, and blood glucoses are transmitted via cellular service in real-time to the telehealth center, where nurses are monitoring the patients. The setting for the implementation of RPM was outpatient, UMMC, Division of Pediatric Endocrinology. Participants were patients aged 0-18 years with type 1 or 2 diabetes. Outcome data for participants was collected via retrospective chart review, for the 12 months prior to enrollment, and up to 12 months following enrollment. Outcome data collected included: HbA1c levels and diabetes related ER visits and hospital visits. Using SPSS, version 25, descriptive statistics were calculated and the paired t-test was conducted (using a level of significance of ≤ 0.05) to determine whether there was statistical evidence that the mean difference between standard care versus RPM for the outcomes of HbA1c, ER visits, and hospital admissions was significantly significant. Outcomes: Hemoglobin A1c levels decreased from baseline for patients enrolled for up to 3 months (p=0.146), 9 months (p=0.142), and 12 months (p=0.007), and increased for those enrolled for up to 6 months (p=0.743). Emergency room visits decreased for those enrolled for up to 3 months (p=0.037), 6 months (p=0.388), and 9 months (0.054); however an increase was noted for patients enrolled for up to 12 months (p=0.822). Finally, for hospital admissions, a decrease was found in those enrolled for up to 3 months (p=0.138), 6 months (p=0.005), 9 months (p=0.021), and 12 months (p=0.819). Conclusion: Consistent with the findings of other meta-analyses focusing on the use of outpatient telehealth, this study’s intervention also resulted in a more substantial decrease in HbA1c than with standard care alone. This may be due to the fact that there was increased contact with the telehealth RPM staff. Additionally, patients in this study received goal-specific education modules via the iPad, which may have also attributed to an overall increase in compliance with diabetes self-management. The ability of the healthcare provider to make insulin adjustments as necessary between visits likely contributed to a decrease in HbA1c levels as well.

2018 Winners

Marik Moen, PhD, RN University of Maryland Baltimore, MD Social Stability as a Consistent Measure of Social Context in a Low-Income Population PhD Program director - Dr. Mary Johantgen

Background and Significance: While researchers are modeling the social contexts in which people are living in studying health and disease, these social determinants of health (SDH) are often conceptualized and measured very differently. Both of these applications of SDH require reliable and valid measures. The construct of Social Stability (SS) developed by German and colleagues (2009) had several advantages: 1) more than one SS domain is necessary to create stability; 2) the inter-connectedness of domains; and 3) the importance of using a defined period of time in measurement. The six domains include: housing, residential/moving, income, employment, legal, and relationship stability over 12 months.

Purpose/Objective(s) and/or Specific Aims: The overall aim of this dissertation was to develop evidence for the use of SS in research and clinical practice. To examine reliability and validity, German’s SS measure was examined in a new population. In addition to overall stability, the prevalence and covariates of individual indicators were explored. Lastly, the relationship of SS to syndemic (co-occurring, interacting) risk behaviors (sexual, substance use, violence) was examined.

Methods: A cross-sectional analysis was conducted from a population (n=503) of heterosexuals at high-risk for HIV infection from the 2013 Baltimore site of National HIV Behavioral Surveillance Study. Data collection occurred via respondent driven sampling (RDS) where study seeds give coupons to potentially eligible participants and refer recruits to study site. This “weighted snowball” approach facilitates recruitment of often hidden populations. The final sample was predominantly African American, half male, with a median age of 37. The SS measure is a self-reported assessment of the six domains over the past year. Outcome variables include sexual risk, violence exposure, and alcohol and drug use variables. Sexual risk indicators include sexually transmitted infection (STI) or HIV diagnosis, multiple partners (2 or more sexual partners in the past year), concurrent partners (having sex with 2 or more partners during same time period), and exchange sex (receiving or giving drugs, money other goods for sex). Violence variables include experiencing threat by weapon, being in physical fight, experiencing physical violence from a partner, or forced sexual encounters. Both SS domain indicators and outcomes were analyzed for individual prevalence and in combination. A syndemic outcome was the co-occurrence of 2 or more of the risk indicators. Descriptive and latent class analyses (LCA) were used to characterize the prevalence and patterns of SS and risk behaviors and to identify SS subgroups. Logistic and latent class regression was applied to model the relationships of SS to risk behaviors and demographic covariates.

Results/Findings: Co-occurrence of SS indicators was common, with an average of 3.4 (SD=1.2) out of 6 indicators of stability. LCA showed evidence for 3 sub-classes: Class 1: overall high stability; Class 2: residential instability (moved in past year); and Class 3: low stability (income, employment instability). Perception or history of stability did not contribute to any improvement in identifying latent classes. Education was an influential covariate in LCA. Those with high school education/GED were nine times more likely to be in “high” vs. “low” SS class (OR=9.37; 95%CI: 2.75-31.82). The most common syndemic risk behaviors were sex-violence-drug, occurring in 18% of the sample. Ordinal and latent measurements of SS reliably predicted individual and combinations of sexual-substance use and violence risks. The latent approach showed higher odds of co-occurring risk for low vs. high SS class (OR= 6.25; 95%CI=2.46, 15.96) compared to using categories for low vs. high SS (OR=2.69; 95%CI=1.29, 5.59).

Conclusion: German’s measure of social stability captures inter-related social conditions across populations and identifies distinct subgroups of in/stability. Each domain of SS should be included and examined, with specific consideration for moving residence which was found to be important in the population studied. Further, ordinal and latent measurements of SS were reliably associated with risk in this population, demonstrating that as SS accumulates, co-occurring (or syndemic) risk diminishes. Furthermore, latent class analysis, which develops classes based on patterns of answers to a set of categorical variables, is a good approach to examine co-occurring predictors.

Background and Problem Statement: Sleep and epilepsy have a complex reciprocal relationship. Sleep-related breathing disorders that can occur in epilepsy are well recognized and a potentially dangerous risk factor for cardiovascular diseases, perioperative morbidities, increase in body mass index, cognitive impairment, unintentional injuries, changes in neuroendocrine, immune and inflammatory systems, depression, sudden unexpected death in epilepsy, increased frequency of seizures, and overall decreased quality of life (Faraut et al, 2012; Panossian et al., 2013). Undiagnosed and untreated obstructive sleep apnea (OSA) is also a potential dangerous risk factor for increased seizure frequency, particularly nocturnally, for adult patients with epilepsy. The American Academy of Neurology (AAN) in their clinical quality measures, indicate a need for provider’s to address safety issues and to intervene to reduce seizure frequency to zero. Patients can easily be screened for OSA with established markers that are strategically placed in the electronic health record (EHR) platform as a reminder to complete.

Purpose/Objective: The DNP student developed, implemented, and evaluated the effectiveness of adding an EHR alert with Assessment of Obstructive Sleep Apnea (AOSA) for assessment of patients with epilepsy by determining the percentage of patients referred for polysomnography (PSG). A 3-month retrospective chart review of adults with epilepsy was conducted to determine the percentage of patients screened for OSA and referred for PSG. The AOSA was added to the EHR to cue neurology providers to screen for OSA for 3 months. Percentages of referrals of patients with epilepsy for PSG before and after adding the AOSA EHR alert were compared.

Procedures: An urban university hospital was the setting for this study. Adult patients 18 years of age and older with epilepsy from the hospital’s seizure and neurology clinics were included. Children were excluded due to their sleep/wake cycle continuing to mature, changing body mass index (BMI), genetics, mandible, airway, tonsils and adenoid growth, and the behavioral factor of sleep-onset association disorder. After approval by the institutional review board, a review of the literature was conducted and an assessment tool was developed with 12 primary and 9 secondary risk factors with subsequent ordering of a PSG if >2 risk factors were present. The board-certified sleep medicine physician provided content validity. The AOSA tool was embedded in the EHR after approval by the institution’s EPIC steering committee. A 3-month retrospective chart review was conducted with the collection of sex, age, and data from OSA screening performed and referral for PSG. A second set of 3-month data were collected after inclusion and implementation of the AOSA in the EHR. The percentage of adult patients screened and referred for a PSG before and after integration of the AOSA in the EHR was determined. Pearson’s Chi Squared test (x2) was used for data analysis. The GraphPad Prism 7 program was used to calculate the Chi-Squared test for the quantitative data to determine if an increased proportion of patients were screened as positive for OSA with an EHR alert and referred for a PSG.

Outcomes: The three-month retrospective chart review indicated that no patients were formally screened for OSA prior to introduction of the EHR alert, yet 25 (7.2%) of the 346 subjects were sent for a PSG, presumably based on patient report, history and exam findings. Following the addition of a simple AOSA tool in the neurology section of the EHR, 405/414 patients (97.8%) of patients were screened for OSA and 134/405 (33.1%) were referred for a PSG. There was a significantly increased number of patients identified with OSA after the implementation of the AOSA (x2 value = 74.7, df = 1, p<0.001).

Conclusion: The results of this quality improvement project supported the assessment of adult patients with epilepsy for OSA with a prompt in the EHR. The added prompt increased the percentage of patients receiving a referral for a PSG to objectively determine OSA. In view of the clinical and public health implications of untreated OSA, screening in high-risk populations, such as patients with epilepsy, warrants implementation. Adoption of screening tools into the EHR may help to facilitate practice transformation and identify OSA as a potential risk factor for the proliferation of seizures in patients with epilepsy.

2017 Winners

Kristen Weaver, PhD, RN New York University New York, NY Brain-gut Axis Dysregulation in Patients with IBS; An Exploratory Investigation for Markers of Stress. PHD Program director - Dr. Allison Vorderstrasse

This three-part investigation analyzed participant data from a parent investigation at the National Institutes of Health. Participants included males and females who identified either as HC or patients with IBS. The first investigation (N=101) revealed differential findings in psychological stress markers by IBS diagnosis, as well as sex, race and subtype differences in the stress response of IBS participants. These findings were used to optimize the second investigation, which analyzed expression levels of genes that may affect psychological and gastrointestinal processes, through the creation of a custom PCR array. IBS participants were found to differ from HC (N=48) in expression levels of six genes associated with immune activation, stress, psychological and antimicrobial processes. Additional analyses within female IBS participants, revealed a significant difference between subtypes in gene expression levels related to pain sensation. The third dissertation study harnessed the power of shotgun proteomic analysis, to identify circulating serum proteins that differentiate a homogenous set of IBS participants from well-matched HC (N=6). Analysis of 1,317 proteins revealed a significant difference in 12 proteins between IBS and HC participants, with biological associations including platelet activation/degranulation, platelet alpha granule lumen, secretion by cell and extracellular region.

This dissertation investigation revealed preliminary though promising findings of psychological, physiological, genomic and proteomic differences between IBS participants and HC, and within IBS participants. By exploring downstream effects of noted sex and subtype differences, this study may foster insight on physiological underpinnings of IBS and promote understanding of BGA dysregulation. By illustrating the heterogeneity of the IBS patient population, this study highlights the importance of an individualized approach to patient care, thus working to improve clinical outcomes of patients living with the disorder.

Honorable Mention went to:

Latefa Dardas , PhD, RN, CDE; Duke University A Nationally Representative Survey of Depression Symptoms among Jordanian Adolescents: Associations with Depression Stigma, Depression Etiological Beliefs, and Likelihood to Seek Help for Depression.

Purposes/Aims: This project was designed to identify and evaluate key challenges a rural hospital has in providing a reliable best practice response for an Emergency Cesarean Section (ECS). Decision to Incision times (DIT) when confronted with an ECS along with newborn outcomes were studied. The study also conducted and analyzed staff questionnaires to evaluate staff attitudes, perceptions, role clarifications, driving and restraining forces in an ECS.

Rationale/Background: American Congress of Obstetrics and Gynecology (ACOG) recommend that obstetrical services be able to reliably perform an ECS DIT in 30 minutes or less. Seventy percent of neonatal brain injury may occur in the intrapartum period (AWHONN, 2015). Rural hospitals often perform all cesarean sections in the operating room domain with experienced operating room staff rather than obstetrical nurses trained in circulation and scrub. Rural hospitals are fraught with challenges around 24/7- hour/day availability of skilled anesthesia and surgical staff needed for an ECS. The Institute of Medicine, (2005) remarked that rural hospitals do not regularly have the census to finance operating rooms and anesthesia to be in house always. Rural multidisciplinary staff often feel unsupported and feel incompetent with oversaturated responsibilities. Night shifts (PM) and weekends are left vulnerable to prolonged DIT’s for an ECS.

Methods: Five years of Emergency Cesarean Section outcomes were analyzed (records review) to evaluate a rural hospital system in providing a reliable “best practice” response as recommended by ACOG. Outcomes (DIT’s and newborn) evaluated, included pre-intervention and post-intervention quality improvement(QI) project initiated by this author. Statistical tests include: t-Test for independent groups and mean scores, 5-minute Apgar mean scores, with nominal data for infant respiratory distress and hospital transfer. Staff questionnaires included a Likert scale that involved questions about staff encounters when an ECS was performed. The questionnaire also employed a ranking section about the staff’s personal perceptions about restraining and driving forces as described by the Kurt Lewin theory.

Outcomes achieved: Decision to Incision t-Test for independent groups analyzed, not statistically significant, (n=19, t=.88, alpha .05, two tailed, critical value,211, df17). Clinical significant ascertained that mean DIT scores were improved post-intervention by 7 minutes. Pre-intervention=DIT @ 37.2 minutes and Post-intervention=DIT @ 30.2 minutes. Evening shift (PM) and weekend, overall scores, demonstrated prolonged DIT mean scores, AM (n=8) =26 minute, PM/weekend (n=11) =42.3 minutes. Pre-implementation DIT AM=37.2-minute, Post implementation=25.6 minutes. Pre-implementation DIT PM/Weekend=41.2 minutes, Post=41.8 minutes. Staff questionnaires revealed that the staff believes that “best practices” are attainable for an ECS in this facility. The staff questionnaires also ranked that there was a lack of training surrounding an ECS, rural skill oversaturation requirements, and unity resistance between the Operating Room staff and Labor and Delivery staff when an ECS was called. The staff ranked the chief driving force as the importance of good newborn outcomes.

2016 Winners

Erin Downey, DNP Duke University Durham, NC Implementation of a Patient Agreement for Opioids and Stimulants in a Primary Care Practice Chair - Paula Tanabe, PhD

The dramatic increase in the consumption of controlled substances in North Carolina and across the nation has created a public health crisis with epidemic levels of medication diversion, misuse, abuse, unintentional overdose and death. Primary care providers are the principal prescribers of controlled substances and therefore at greatest risk of encountering patients that abuse medications. Guidelines recommend patient agreements with specific monitoring requirements when prescribing Schedule II medications (opioids and stimulants). Studies have focused solely on opioids and excluded stimulants and adherence to all recommended monitoring requirements has not been fully evaluated in the literature. Patient agreements were not previously used in the project practice site.

Implement a Schedule II controlled substance patient agreement and measure fidelity to components of the agreement.

A quality improvement framework using Plan-Do-Check-Act was used to design and implement the project. An opioid and stimulant prescribing policy and patient agreement was developed from sample agreements and based upon existing evidence with input from the practice partners. The policy applied to all patients aged 19 and over prescribed a long-term Schedule II medication for the chronic conditions of pain and/or attention deficit hyperactivity disorder. Examples of Schedule II narcotics include: hydrocodone, hydromorphone, oxycodone, fentanyl and methadone. Stimulants include: amphetamine, methamphetamine, and methylphenidate. All providers in the clinic received education about the policy. Adherence to the following outcome measures (elements of the protocol) were evaluated monthly: patient signed Schedule II agreement on file, prescription monitoring program (pmp) checked prior to writing a Schedule II prescription, urine toxicology screens, and prescriptions written without a mandatory visit. Monthly feedback was given to the providers over the course of the project. Modifications to improve adherence were made as needed. Outcomes were compared seven months pre- to seven months post-implementation of the patient agreement. Wilcoxon signed rank test and McNemar test were used to analyze differences in adherence between the pre and post implementation time period.

Fifty patients met study criteria and were included in the analysis. The mean (SD) age was 50.7 (16.3). The majority of patients were white (96.0%) and female (62.0%). An almost equal proportion of patients received medication for chronic pain (50%) and attention deficit hyperactivity disorder (46%). Four percent of participants received medication for both diagnoses. The percent of guideline adherence to each outcome improved from pre to post implementation: Signed agreement in chart (0%, 94%); urine screen guideline (5.3%, 71.1%); pmp checks (11.3%, 99.0%); prescriptions written without a visit guideline deviation, (20.6%, 0). All changes were significant (p < .001).

Implementation of a Schedule II controlled substance patient agreement and prescribing policy in a small primary care practice was feasible and adherence to the policy was excellent over a 7-month period.

Dissemination: The manuscript is under review for publication in the Journal of Family Medicine and Primary Care. The journal audience is family practice providers who frequently struggle with the complexity of prescribing chronic opioids. The project results will be shared at an evidence-based research conference scheduled for September 2016 at UCLA.

Continued implementation: All providers in the practice continue to follow the policy and are initiating patient agreements for new patients as well as following all aspects of the protocol. Monitoring for adherence is ongoing.

Sustainability and cost: The cost of implementation was not measured directly, but has proven to be minimal. In North Carolina, the prescription-monitoring program is state funded with free access to registered users. All project-associated tasks such as presentation and explanation of the patient agreement and urine collection were completed within the normal workday and did not require additional man-hours. In March 2016, the Centers for Disease Control and Prevention (CDC) issued the Guideline for Prescribing Opioids, http://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.

The protocol we implemented included almost all aspects of the guideline, which should increase the probability of associated costs being covered by insurance. All of these factors enhance the project’s sustainability.

Sarah Farabi, PhD University of Illinois at Chicago Chicago, IL Sleep, Glucose Variability and Cardiovascular Disease Risk in Young Adults with Type 1 Diabetes Chair - Mariann Piano, PhD

People with type 1 diabetes mellitus (T1DM) experience high glucose variability and frequent hyperglycemia. Poor glucose control is known to contribute to accelerated cardiovascular disease (CVD), a leading cause of death in people with T1DM; however poor glucose control does not completely explain the increased risk. Good sleep also has been shown to play an important role in maintaining cardiovascular and metabolic health. Sleep quality is reduced in people with T1DM, but the reasons for poor sleep quality are not known. There has been minimal research into the relationship between glucose variability and sleep disruption in young adults with T1DM.

Hypotheses and Specific Aims: To test the hypotheses that glucose variations are causally related to sleep disruption and that sleep disruption mediates inflammation and CVD risk in individuals with T1DM, two aims were proposed: 1) to quantify sleep disturbances and to determine their relationship to glucose variability and 2) to define the relationship between sleep disruption and markers of CVD risk in young adults with T1DM.

A prospective, cross-sectional design was used. Young adults, age 18-30, who had diabetes for at least 5 years, wore an insulin pump and had a normal sleep schedule were enrolled. Subjects wore a continuous glucose monitor (CGM) and a sleep/activity monitor in home for three days and two nights and underwent a formal sleep study, polysomnography (PSG), while wearing the CGM in the laboratory at the University of Illinois at Chicago on the third night. The CGM is a validated tool that provides an updated glucose value every five minutes. Total time in bed was between 7-8 hours; blood was drawn just before lights out (pre-sleep); at lights on (awakening) and one hour after lights on(1-hr post awakening) to measure amounts of CVD risk markers, inflammatory cytokines, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α). The amount of power in five electroencephalogram (EEG) Bands – Delta and Theta (characteristic of sleep); Alpha, Beta and Gamma (characteristic of wakefulness) – was tracked throughout the PSG study night. Wavelet coherence analysis was applied to determine time varying and frequency specific relationship between glucose levels and the five EEG bands. Granger causality analysis along with vector coefficient analysis was applied to the glucose and five EEG bands to determine if potential causal interactions between glucose and EEG during sleep. Levels of IL-6 and TNF-α were determined using Enzyme linked immunosorbent assays (ELISA) and one-way ANOVA (Scheffe’s test for multiple comparisons) was applied to compare between the pre-sleep, awakening and 1-hour post awakening time points.

27 subjects (11 males, average age 23.9±4.1 years) were included in the analysis. Wavelet Coherence Analysis revealed a strong time-varying and frequency specific coupling between glucose and EEG, rapid fluctuations were more strongly coupled and exhibited more instances of strong coupling through the night (p<0.0001). 96.2% of subjects exhibited at least one instance of significant Granger causality between Glucose and EEG bands. Increasing glucose was causally related to increasing Alpha and decreasing Theta and Delta power, changes in the EEG signal which are consistent with an arousal or sleep disturbance (p=0.01). Increases in Delta (increases during deep sleep) consistently caused increasing glucose levels while increasing Theta (increases during rapid eye movement sleep) caused decreasing glucose. TNF-α was higher on awakening (1.44±0.66 pg/ml [SD]) and 1-hour post awakening (1.6±0.62 pg/ml) compared to pre-sleep (0.96±0.48pg/ml) (p<0.0001 for each). Subjects with good glycemic control exhibited a normal pattern of decreased IL-6 upon awakening.

Findings from the present study support a potential bi-directional causal relationship between glucose and brain activity during sleep. Increasing glucose led to changes associated with a sleep disturbance (increasing arousals and awakenings). Further, normal changes in the sleep process, were causally related to changes in glucose. The current findings also support that the sleep period may play an important role in increasing inflammation, a key mechanism in development of cardiovascular disease in people with T1DM. Collectively, findings from this study highlight the importance of the sleep period for glycemic control and inflammation in people with T1DM.

Sleep is a potentially modifiable behavior is increasingly recognized as playing an important role in maintenance of health. The findings from this study highlight that glucose variability during sleep may play an important role in disturbance of sleep, but also that sleep may influence glycemic control. This foundational evidence provide motivation for future interventional studies aimed to determine the mechanisms underlying the relationship between glucose variability and sleep disruption as well as the role of this relationship in development of CVD. Understanding how glucose variability and sleep disruption accelerates CVD may allow for improved diabetes nursing management strategies. Nursing interventions aimed at improving glycemic variability or minimizing sleep disturbances may help to improve glycemic control, decrease CVD development and ultimately improve quality of life in people with T1DM.

2015 Winners

Jennifer Dine, PhD University of Missouri Columbia, Missouri Characterization of a Novel Regulator and Predictors of Sensitivity to TRAIL-induced Apoptosis in Breast Cancer Cells Chair - Dr. Jane M. Armer

Tumor necrosis factor-related apoptosis inducing ligand (TRAIL) is a protein that selectively induces apoptotic cell death via TRAIL receptor (TRAIL-R) activation in cancer cells. TRAIL-R agonists have been well-tolerated but demonstrated very little activity in patients. Interestingly, triple negative breast cancer (TNBC) cells were found to be sensitive to TRAIL-induced apoptosis while breast cancer cells representative of the other subtypes (estrogen/progesterone receptor positive or HER2 amplified) were comparatively resistant in vitro. Characterizing regulators and predictive biomarkers of TRAIL-R agonist sensitivity may help identify TRAIL-R sensitizing combinatorial therapies and TNBC-affected patients who might benefit the most from a TRAIL-R agonist therapy.

The first objective was to characterize the protein, gp78, as a negative regulator of TRAIL-induced apoptosis in breast cancer cells. The second objective was to evaluate the sensitivity of different subtypes of breast cancer cells in vitro to drozitumab, a TRAIL-R agonist that was well-tolerated in patients. The third objective was to identify potentially predictive biomarkers of TRAIL-R agonist sensitivity. The fourth objective was to evaluate expression of the potentially predictive biomarkers in patient samples. To address the first objective in evaluating the negative regulatory effects of gp78 on TRAIL pathway sensitivity, gp78 function was transiently inhibited using 10 gp78-targeting siRNAs in the TNBC cell lines MB231. gp78 function was also chronically inhibited by generating MB231 cells with stable gp78 knockdown. Cells with and without gp78 knockdown were then treated with and without TRAIL, and loss in cell viability and caspases-3/7 activity, which is a direct measure of TRAIL pathway activation, were assessed. To address the second objective, a panel of breast cancer cell lines representative of the different subtypes of disease (estrogen/progesterone receptor positive, HER2 amplified, and TNBC) were treated with and without drozitumab and evaluated for loss in viability. To address the third objective, immunoblot analyses were used to assess for potentially predictive protein markers of drozitumab sensitivity in the cell lines used in the second objective. Finally, to address the fourth objective, 177 TNBC tumor samples from a publically available cDNA microarray dataset were evaluated for the differential transcriptional regulation of genes whose protein products were identified as potentially predictive biomarkers of drozitumab sensitivity in the third objective. Additionally, 53 TNBC tumor samples were evaluated using immunohistochemistry to assess the protein expression of the identified potentially predictive biomarkers using a clinically relevant assay system.

The results from the first objective indicated that gp78 inhibited TRAIL-induced apoptosis in breast cancer cells in a mechanism that was dependent on the cell death-mediating proteins, caspases. The findings from the second objective demonstrated that TNBC cells, but not breast cancer cells representative of the other subtypes of breast cancer, were sensitive to drozitumab-induced cell death. In the third objective, the proteins Axl and vimentin were expressed only in the breast cancer cells that were sensitive to drozitumab-induced cell death. Axl and vimentin were thus selected as candidate predictive biomarkers of TRAIL-R sensitivity. Finally, in the fourth objective, Axl and imentin were found to be highly transcriptionally co-expressed (p<0.0001) in the cDNA microarray datasets of 177 TNBC tumors and were also highly co-expressed in the top quartile of Axl and vimentin-expressing tumor samples in the 53 TNBC tumor samples characterized by immunohistochemistry.

The findings from this study demonstrate that gp78 negatively regulates TRAIL-induced apoptosis in a caspase-dependent manner. TNBC cells were also determined to be sensitive to drozitumab, a TRAIL-R agonist, and those cells also expressed the proteins Axl and vimentin. Axl and vimentin were identified as candidate predictive biomarkers of drozitumab sensitivity and were determined to be expressed in human TNBC tumors at the transcriptional and protein levels. Therefore, Axl and vimentin expression in tumors may be utilized to aid in the selection of TNBC-affected patients who might benefit from a TRAIL-R agonist therapy.)

The findings from this study characterize the protein gp78 as a novel negative regulator of TRAIL-induced apoptosis. Little is known about the regulatory mechanisms that govern TRAIL sensitivity in cancer cells. Therefore, these findings contribute significantly to an area of TRAIL-related research that has been poorly described. The gp78 protein may also provide information about targetable pathways in cancer cells that could be inhibited or enhanced pharmacologically to promote TRAIL-R agonist activity in patients. The identification of the potentially predictive biomarkers of TRAIL-R agonist sensitivity, Axl and vimentin, may also aid in promoting TRAIL-R agonist activity in patients by helping identify those individuals whose TNBC tumors would most likely respond to a TRAIL-R agonist. In light of the limited success of TRAIL-R agonist strategies tested in clinical trials to date, using predictive biomarkers is a novel but potentially highly useful system for selecting patients for TRAIL-R agonist treatment. Collectively, these findings reflect elements from across the translational spectrum with respect to describing the fundamental regulatory processes of a biological system to the application of clinically relevant strategies for improving therapeutic effectiveness in patients.

Veronica Brady, PhD, RN, FNP-BC, BC-ADM, CDE; University of Texas Health Science Center at Houston Prevalence of Steroid Induced Hyperglycemia in Patients with Mantle Cell Carcinoma Receiving High Dose Steroid

Ariana Chao, PhD, FNP; Yale University Obesity-Related Eating Phenotypes and the Relationships with Food Cravings, Stress, and Metabolic Abnormalities

Michelle Davis, DNP, NNP, RNC-OB Arizona State University Implementing Skin-to-Skin Contact in the Operating Room Following a Cesarean Delivery DNP Program Advisor- Dr. Heather Ross

Cesarean delivery is the most common major surgical procedure in the United States, representing 38.2% of live births in 2012 (Boyle et al., 2013). Infants delivered by cesarean section may face a more difficult transition to extrauterine life due to retained fluid within the alveoli (Blake & Murray, 2006). Skin-to-skin contact (SSC) and breastfeeding have been shown to help these newborns. However, one large urban medical center in the Southwest US did not have a policy to support immediate SSC and breastfeeding after cesarean delivery. This was a barrier to obtaining “Baby-Friendly Hospital” status (Baby-Friendly USA, Inc., 2012), despite being a Magnet hospital credited by the American Nurses Credentialing Center for excellence in patient care – with a level III perinatal and neonatal unit. The medical center is a busy urban academic hospital with 5,847 infant deliveries in 2013.

An evidence-based pilot protocol for SSC in the operating room (OR) immediately following a cesarean delivery was implemented in order to provide clinical impact data. Immediate SSC in the OR helps newborns adapt to extrauterine life and assists with infant-parent bonding and breastfeeding success. SSC can decrease the amount of time the infant spends in the Neonatal Intensive Care Unit (NICU), resulting in fewer nursing hours and overall cost savings for both hospital and patients.

The EBP project was conducted with approval from the Institutional Review Board at Arizona State University with reciprocal hospital agreement. The 7-step Iowa Model of Evidence-Based Practice (EBP) guided the EBP project. Step 1: topic selection (discussed above). Step 2: EBP team was formed and met biweekly, with members including project lead (L&D nurse and DNP student), L&D nurse manager, surgical scrub technician, obstetrician, nursing representative from the nursery team, and anesthesiologist. Step 3: systematic evidence retrieval to support the “triggering" question. Step 4: EBP team critically appraised the evidence to build obstetric section stakeholder buy-in. Step 5: development of standards for the pilot SSC protocol. Step 6: 3-month implementation of the pilot SSC protocol for all mother-infant dyads admitted for scheduled or repeat cesarean delivery with a live, singleton fetus greater than 37 weeks gestation, with no pre-existing medical complications or fetal anomaly (n=193). Nursery staff tracked neonatal outcomes including temperature, respirations, glucose, and disposition during the two-hour transition after birth. These data were compared to historical data for mother-infant dyads meeting protocol inclusion criteria in the 3 months prior to protocol implementation (n=302). A double-entry process was used to verify the data. Data were analyzed using chi-square test to compare rates of SSC application and infant disposition, and paired t-test to compare pre- and post-protocol neonatal outcomes including temperature, heart rate, respiratory rate, and blood glucose. Step 7: evaluation of the overall SSC procedure, including process review, outcomes data, and staff feedback for protocol evaluation and modification.

There were no baseline demographic differences between pre- and post-intervention groups. Neonatal outcomes were significantly different for infant temperature (SSC = lower), heart rate (SSC = lower), respiratory rate (SSC = lower), and blood glucose (SSC = higher) between pre- and post-intervention groups. Notably, SSC resulted in statistically and clinically significant reduction in hypoglycemia (p = .002). Additional outcomes included an increase in exclusive breastfeeding by 38.3% (p=0.000) in the intervention group, and an 84% decrease in NICU admissions (p=0.000) in the intervention group. SSC in the OR is a valuable and feasible intervention following a cesarean delivery, with no additional expense to the facility, and potential for significant cost savings due to deceased NICU admissions. This EBP outcome supports the American Academy of Pediatrics’ (AAP) recommendation for SSC in the first hour after birth (AAP, 2005) and promotes exclusive breastfeeding, one of the Joint Commission’s mandated initiatives (United States Breastfeeding Committee [USBC], 2010) and Healthy People 2020 goal ((Office of Disease Prevention and Health Promotion, 2015). The average cost of NICU admission for a normal term infant for hypoglycemia and hypothermia is $76,164 (March of Dimes Perinatal Data Center, 2011). This EBP SSC intervention reduced NICU admissions by 84% for normal term cesarean section births, representing $2 million cost savings to the hospital over 3 months.

The results of this EBP study led to the medical center including the SSC intervention in all new hire training and required annual skills competency training for seasoned employees. This training addition required minimal resources and additional costs or staffing.

The SSC intervention is included in the existing charting system. This EBP project has been disseminated at the following events:

• Arizona Nurses Association Conference, October 2014 – poster
• Highlighted in the Chief Nursing Officer’s Weekly Journal - October 2014
• Medical Center’s Poster Walk Showcase, November 2014
• Voted as the “Best Practice” Innovation for the medical center
• Systemwide Shared Governance Conference April 2015 - podium
• Advance Practice Neonatal Forum in Washington, D.C., May 2015 – podium and poster
• Highlighted as part of the medical center’s Magnet Documentation and presented to Magnet recertification evaluators, July 2015
• Invited podium presentation at the National Phoenix Perinatal Associate Challenges in Obstetric Care Conference, April 2016

Susan Klein, DNP, FNP-C, OCN; University of San Diego Transition After Breast Cancer Treatment: Implementing Survivorship Care Plans

2014 Winners

Kathryn (Kim) Friddle, PhD, APRN, NNC-BC University of Utah College of Nursing Retinopathy of Prematurity: The Effects of Oxygen Saturation Targets in At-Risk Neonates PhD Program Chair - Dr. Patricia Aikins Murphy

Background and Significance:  Retinopathy of prematurity (ROP) is a potentially blinding disorder estimated to affect 14,000 to 16,000 infants with 500-700 becoming legally blind annually. It is known to be associated with preterm birth, low birth weight, and the use of oxygen. An optimal oxygen saturation range of 85-93% is often targeted to minimize the risk of either hypoxia or hyperoxia. Maintaining premature infants within the targeted range can be difficult with many infants spending significant amounts of time both above 93% and below 85%.

Purpose/Objective(s) and/or Specific Aims : The purpose of this research was to evaluate whether the development of ROP can be explained by the average percentage of time in a 24-hour period that the infant spends out of the targeted oxygen saturation range in the weeks prior to the development of ROP or retinal maturity. Additionally, the effect of higher oxygen saturation targets while an infant is receiving 21% oxygen was evaluated to determine whether this increases the risk of developing ROP.  Finally, the study addressed whether death before discharge can be explained using the average percentage of time during 24-hours that the infant spends out of the targeted oxygen saturation range.

Methodology/Procedures: The study used an observational, retrospective, and longitudinal design, tracking standard practice in a level IV referral center NICU. Weekly 24-hour histogram reports, generated from the Phillips IntelliVue™ Monitor detailing individual patient oxygen saturation levels, were collected and evaluated for the percentage of time the infant spent above and/or below a targeted saturation of 85% and 93%. Multinomial logistic regression was used to evaluate nested patient data of at-risk infants cared for at Primary Children’s Hospital, a free-standing children’s hospital, over a 3-year period. Data were entered longitudinally until retinal maturity/ROP occurred (N=241ROP study) or until death/discharge (N=250 survival study). Infants were excluded from both studies if ROP was present prior to admission, or death/discharge occurred without an eye exam or data collection.  Survival analysis using a discrete-time hazard model was used to explain the risk of developing ROP (stage 1 or ≥ stage 2) or death, associated with the time above and below the targeted range, controlling for the effects of gestational age and birth weight using logistic regression. The ROP model included a cubic time trend to reflect the average change in probability of developing ROP, and the survival model used a quadratic time trend for the risk of death.

Results/Findings: The total time the infant was out of targeted saturation range had no effect on the development of ROP. However, for every 2.7% of the time the infant spent ≤ 85%, the risk for ROP increased by 48% (p<0.038), and the risk of death increased by 11% (p<.001). The percentage of time an infant spent >93% decreased their risk of ROP and death. For every 10% of time spend >93%, the risk of ROP decreased 21%, and the risk of death decreased 11%. The time breathing 21% oxygen was added into the regression equation at all levels, it was not found to be significant for the prediction of ROP.

Conclusion(s): The optimal saturation range for infants at risk for ROP is not known. These data raise concerns about the appropriateness of the current saturation targets of 85%-93%. This supports the current recommendation of many that the targeted saturation range for this population should be higher. A low saturation level of 85% cannot be recommended as safe given the results of this study.  The upper limit of time for saturations >93% to be beneficial remains unknown and needs further research.

Implications/Recommendations for the Profession and/or Science: This is the first study to report the impact of the time a premature infant spends out of the targeted saturation range of 85-93%. It is also the first study to report the effects of high saturations while the infant is breathing 21% oxygen on the development of ROP.  The current research study provides important information on the effects of time spent with both low and high oxygen saturations on the development of ROP and death.  Infants in this study population largely represent infants in phase 2 ROP (31-44 weeks). It has shown that low saturations (≤ 85%) are detrimental, with increased risk for the outcomes of both ROP and/or death, while  high saturations (> 93%) improves the risk of both of these outcomes. This study also supports the use of oxygen saturation histogram data in clinical practice to evaluate an infant’s ability to maintain a given saturation target to help guide respiratory management decision-making within this high risk population. These monitoring tools can help answer important clinical questions about the impact and management of low and/or high saturations.

Honorable mention went to:

Qiaohong Guo , PhD, RN, University of Massachusetts Amherst School of Nursing A Preliminary Model of Dignity Management in Hospice

Angela Smith Lillehei , PhD, MPH, RN, University of Minnesota School of Nursing Effects of Lavender Aromatherapy via Inhalation and Sleep Hygiene on Sleep in College Students with Self-reported Sleep Issues

Jessica Kozlowski, DNP, CPNP-PC Brandman University School of Nursing and Health Professions Pediatric Nurse Practitioner Management of Child Anxiety in the Rural Primary Care Clinic DNP Project Chair - Dr. Pamela Lusk

Background and Problem: Pediatric Nurse Practitioner (PNP) encounter children with concerns for a mental health disorder in their clinical practice, with only 20 percent of these children having any treatment often due to barriers to care such as poor mental health care access, social stigma, or other parental factors.  Anxiety disorders are the most common pediatric mental health disorder an estimated prevalence of 5 to 18 percent.  An estimated $247 billion is spent each year on childhood mental disorders including anxiety with 75 percent of these children presenting to the primary care setting for diagnosis and management. Because of the impact on children, families, and communities, children's mental disorders are an important public health issue in the States.

Purpose/Objective(s): The purpose of this capstone project was to offer evidence-based treatment option for PNP in the primary care setting for children with an anxiety disorder.  The primary care setting in the model of care discussed by the Substance Abuse and Mental health Services Administration (SAMHSA –HRSA Center for Integrated Health Solutions) can be a location for screening (S) and brief intervention (B-I) before referral to subspecialty if needed.  The brief intervention, Creating Opportunities for Personal Empowerment (COPE), is a manualized 7 –session program, that can be delivered by a trained PNP to offer skills similar to Cognitive Behavioral Therapy.  

Procedures: This was a pilot study completed at a Federally Qualified Health Clinic in the rural Northwest area of Florida.  A convenience sample of 14 children ages 8 to 13 years was utilized once they met the criteria of having an anxiety disorder based on DSM 5 criteria.  Exclusion criteria included any mental retardation, psychosis, or current suicidal thoughts.  The intervention, COPE appointments were 30 minutes in length and scheduled at the families preferred time.  The core concept which is a subset of techniques in CBT was presented to the child; then reinforced through games, interactive activities, and finally real life application of these concepts.

Anxiety symptom reduction has been considered the gold standard of improvement after intervention which was measured utilizing the reliable SCARED symptom checklist with a score less than 25 equaling no anxiety symptoms. Level of functioning was assessed using the Clinical Global Impressions Scale.  Children assess their improvement in functioning by answering the question “After the COPE program, how is your home and school life?”  Improvement is seen with a score of 2 or higher (much improved to very much improved) which is consistently used in the literature with pediatric anxiety.  Cognitive - behavioral skills learned through the COPE program were assessed through a 15 question content quiz given before and after all 7 sessions were complete. Finally, program satisfaction was measured through open-ended questions for both the parent and child.

Outcome(s): Children who participated had significant decreases in anxiety symptoms (13.88 points, SD = 17.96, 95% CI -1.13, 28.89) and on post assessment 50 percent of the participants no longer met criteria for an anxiety diagnosis.   They also had increases in knowledge of cognitive – behavioral coping skills (M=11.38, CI 5.99, 8.26, p = 0.00) and 100% showed improved functioning at both school and home on self-evaluation.  Evaluations by parents and children were positive with 100 % of participants and parents preferring delivery of COPE in the primary care setting and recommending the program to another child.

Conclusion(s): COPE visits fit into the fast - paced pediatric practice in 20 - 30 minute sessions.  COPE sessions were billed and all were reimbursed by the insurance providers at the higher CPT code for time of over 50% of the visit in counseling (99214) indicating this is a cost effective intervention in primary care.  Post COPE evaluations indicated improved patient outcomes. There was one child who had a worsening of anxiety score on SCARED after COPE delivery.  This child was dealing with social changes that were identified during individual sessions.  With the S-B-I-R-T treatment model in mind after COPE sessions were completed then the patient was referred to a mental health provider for a longer intervention.

Implications for Practice or System Change(s) : With the call to arms across both psychiatric and pediatric organizations to offer effective, evidence-based mental health treatment no matter the treatment location, the PNP is in a unique opportunity to intervene early in the child’s anxiety diagnosis.  With early, effective interventions this anxiety diagnosis will be less likely to follow the child into adulthood.

The Triple Aim of Healthcare views successful interventions that are cost effective, patient centered and improve patient outcomes.  The COPE program meets these three criteria, which was disseminated at the DNP Convention (Fa    ll of 2014).  PNPs continue to practice in the front lines in rural areas, with the largest need for mental health support.  To offer this program to other PNPs this project will be presented at the National Association for Pediatric Nurse Practitioners conference in March.  Journal submission has also been completed for consideration for the Journal of Pediatric Healthcare.  The lead researcher continues to perform COPE in her daily practice, with 10 children completing since the project ended.

Kathryn Evans Kreider , DNP, FNP-BC, Duke University School of Nursing

2013 Winners

Nancy Crego, PhD, RN, CCRN University of Virginia Pediatric Sedation Safety Dissertation chair, Dr. Elizabeth I. Merwin

Background: Every year, thousands of children require sedation for diagnostic and interventional procedures. Despite regulations by accreditors and guidelines by professional organizations, adverse sedation events and variations in how sedation care is delivered continue to occur.

Purpose: This study presents a review of sedation standards shaping RN practice and exemplars of state Boards of Nursing sedation regulations in the United States.

Methods: The Pediatric Sedation Research Consortium (PSRC) database was used to learn more about RN sedation practices in diagnostic radiology; findings revealed that RNs often plan to achieve deep levels of sedation and administer combinations of two or more sedative medications for diagnostic procedures. Outcomes of sedation for cases where RNs monitored and delivered sedation alone were compared to outcomes of RN and physician teams and physicians working alone to deliver sedation. Cases in which RNs alone provided sedation had similar American Society of Anesthesiologists risk scores compared to cases with physicians alone and RN and physician sedation teams.

Results: Adverse event rates in sedated children range from 0.4% to 20.1% in the U.S., and include cases of desaturation, inadequate sedation, and respiratory depression requiring bag valve mask ventilation. The rate of sedation adverse events when RNs provide sedation is unknown due to small sample sizes and few RNs participating in reported studies. Limitations of most investigations regarding pediatric sedation include frequent use of single site samples, reporting on only one type of procedure, and using sample sizes that are underpowered to detect sedation adverse events that are estimated to occur once in many thousands of cases. Many studies of RN sedation practice have examined a particular aspect of sedation care, such as determining differences in outcomes of sedation using different sedative medication regimens or the number of failed sedations; these outcomes are not compared to other sedation provider outcomes. As a result, these studies provide limited information on the safety of RN administered procedural sedation, the factors that increase the likelihood of adverse sedation events, and the differences in sedation administered by RNs compared to other sedation providers. Findings revealed that cases in which RNs alone or physicians alone monitored and delivered sedation had lower odds of experiencing adverse events than when sedation was administered by RN and physician teams.

Conclusion: This study revealed inconsistencies in state Board of Nursing regulations and in RN sedation care standards in the U.S. Data from this study could be used to improve RN sedation care processes, and guide the development of consistent nursing sedation licensing regulations, hospital standards, and policies. The lack of data on RN sedation practice and safety hinders the development of evidence-based regulations. Differences in sedation care may be related to the type of specialist providing sedation, their scope of sedation practice, and methods used to induce sedation. Sedation is performed by a variety of health care providers including registered nurses (RNs), but there are limited data on current regulations governing RN sedation, descriptions of RN sedation practice, or comparisons of outcomes of sedation by different types of providers.

Erica Schorr , University of Minnesota

Yafen Wang , Case Western Reserve University

Jennifer L. Titzer, DNP, RN, RT(R), RCIS University of Southern Indiana Nurse Manager Succession Planning: Strengthening Health Systems for the Future Capstone Chair, Dr. Maria R. Shirey

Background: Traditional nurse manager selection methods usually result in promoting excellent clinicians lacking formal education and mentoring. Ineffective nurse manager selection increases role stress, unhealthy work environments, poor patient outcomes and turnover rates. Inconsistent leadership results in a loss of community and employee confidence. Competent and effective nurse managers contribute to a healthy work environment, improved employee morale and favorable outcomes. Succession planning increases nursing leadership competence and continuity. Ensuring a competent nurse manager pipeline demands deliberate and strategic succession planning methods. Healthcare lags behind other business industries in strategic succession planning threatening the future nursing leadership pipeline. Evidence regarding succession planning outcomes is limited and hinders implementation efforts. Deliberate and strategic implementation and evaluation of successful planning is critical.

Purpose: The purpose of the capstone was to develop, implement, and evaluate a nurse manager succession plan at an acute care hospital. The primary project objective was to create a strategic method for identifying and developing intellectual talent creating an internal leadership pipeline. Development of an internal leadership pipeline with the intent of reducing recruitment and replacement costs, decreasing nurse manager turnover, and increasing nurse satisfaction was the end goal.

Methods: Nurses working in an acute care hospital were recruited for participation in a 12 month leadership program. Recruitment included completion of a formal and systematic application process. A quasi-experimental one-group pre-test/post-test design evaluated program outcomes. The measurement tools included the Leadership Practices Inventory (LPI) and the Nurse Manager Skills Inventory (NMSI).

Results: A strategic succession planning process was developed at St. Mary’s Medical Center targeting the nursing director position. All staff nurses not formally in leadership roles were invited to apply. Selection was based on an objective scoring worksheet and interview process. There were a total of 12 participants selected and invited into a 12 month leadership development program. Six months into the program, one participant transferred to another facility due to re-location. The remaining 11 participants completed the program. Monthly, six-month, and final program evaluations were overwhelmingly positive and the pre/post leadership and management surveys indicated statistically significant increases in participants’ competency perceptions (p < 0.05). Five nurses from the leadership pool were promoted either during or after program completion (three nursing director and two unit coordinators). In addition, three participants transitioned into quality analyst, staff development specialist, and informatics roles.

Conclusion: The model created for the inaugural program provided a pilot that can be evaluated and adapted accordingly. Ongoing evaluation beyond the initial customer satisfaction and learning and growth metrics will provide a cost benefit analysis and determine a return on investment as well as the impact on the overall nursing satisfaction. Additional recommendations included offering similar programs to professional staff outside of nursing ensuring an organization wide leadership pipeline.

Joelle Hargraves , Chatham University

Rebecca Russo-Hill , Duke University

2012 Winners

Oleg Zaslavsy, PhD University of Washington Longitudinal Dynamics in Indicators of Frailty: Predictors and Long-Term Outcomes Dissertation chair, Dr. Barbara B. Cochrane

Background: Frailty is a common geriatric condition with a wide array of sequelae, including increased risks of mortality, morbidity and disability. Despite its long conceptual and operational history in research and publications, frailty and mechanisms of frailty development are still poorly understood. A detailed description of trajectories of frailty indicators was needed to provide vital insights on unfolding longitudinal dynamics involved in the development of frailty.

Purpose: The specific aims of this study were to: (I) Describe longitudinal (-10 years) trajectories of change in musculoskeletal and neuro-cognitive indicators of frailty in older (>/=65 years) women enrolled in the Women's Health Initiative (WHI) Clinical Trial; (2) Estimate the extent to which baseline factors (e.g., demographic characteristics, health status and behaviors) are associated with a likelihood of membership in the derived longitudinal clusters; and (3) determine the extent to which membership in longitudinal trajectories predicts the incidence of clinically relevant geriatric health outcomes (i.e., mortality and hospitalization) over 5-years of follow up in a model adjusted for all other baseline predictors.

Methods: Data for these analyses came from the WI-II, which included three randomized controlled clinical trials (CTs). Details of the design, recruitment strategies, data collection methods, and tabulations of baseline data are published elsewhere (Anderson eta!. (2003). Implementation of the Women's Health Initiative study design. Annals of Epidemiology, 13, S5-17.). In the present stud y we focused on data from \Vomen ages 65 years and older (at baseline) who emolled in one or more of the CTs and also consented to participate in 2005-2010 Extension Study. The final sample included 19,891 women. Measures of frailty indicators (e.g., physical performance-based tests), demographic, health behavior and status, comorbidity, personality and social factors were collected using well-established objective and self-report measures. Study outcomes of hospitali zat ion and mortality were based on mmual medical history update questionnaires from participants in the 2005-2010 WHI Extension Study. These self-reported outcomes were then used to obtain medical records for adjudication both locally and by a panel of central adjudicators. Latent class growth models were used to identify relatively homogeneous clusters of individuals following similar longitudinal trajectories of change. Trajectory parameters were estimated using maximum likelihood methods. A high-order polynomial function (i.e., quadratic) was fitted to the data, and parameters were estimated to define the shape of the trajectories and the probability of trajectory group membership. The number of clusters were chosen based on standard statistical selection criteria. Partial propmtional odds models were used to fit the data and test the effect of predictors on trajectory group membership. Cox proportional hazard models were used to predict mortality and first-incident overnight hospitalization in sequentially-fitted models.

Results: Study findings demonstrated a high degree of heterogeneity in longitudinal dynamics of individual frailty criteria. In addition, results showed that age, soda-demographic variables, health status, health behavior, environmental factors and personality traits are important determinants of individual frailty criteria, but their effect on frailty phenotype is complex, presumably due to the multidimensional nature offrailty phenomenon. Thirdly, the magnitude of risk carried by a membership in a certain longitudinal group for each of the defining elements of frailty is closely linked to the distance of that trajectory estimates from the one that represents the most optimal criterion-specific functioning over time. The futher the distance between trajectory estimates of an individual who maintained the highest level of performance (specific to that indicator) and those who demonstrated less optimal functioning, the higher the risk of incidence of adverse health events.

Conclusion: The study provided an empirical determination that distribution-based cross sectional partitioning of frailty criteria seems to be a valid method for defining frailty, given that elderly women maintained approximately similar levels of functioning over time without demonstrating clear accelerated or decelerated longitudinal patterns.

Tiffany Moore , University of Nebraska Medical Center

Erin Harnett, DNP New York University Integrating Preventive Dental Care in a Pediatric Oncology Center Capstone Project Advisor, Dr. Barbara Krainovich-Miller

Background: Dental caries is an infectious process, which may cause serious problems for children both during and after cancer treatment (Haytac, Dogan, & Antmen, 2004; Yeazel et al., 2004). The American Academy of Pediatrics (AAP, 2009, 2010) and the American Academy of Pediatric Dentistry (AAPD, 2008, 2010) recent policies have recommended that primary care providers perform oral assessment, provide preventive dental care during routine well child visits, and refer children to the dentist by age one year. The Surgeon General mandated that the evidence-base about the oral-systemic connection be used to improve the health of all by implementing it in the curricula of all health care practitioners and that a comprehensive oral assessment be a gold standard of practice (IOM, 2011) for the public. The needs assessment of this project uncovered the glaring gap between existing extensive evidence and recommendations regarding the need for oral health assessment and current practice. Although children being treated for cancer are seeing the pediatric oncology team on a regular basis, they are not receiving expected normal pediatric or dental preventive care prior to or during cancer treatment. This issue is of paramount concern as the development of oral problems during childhood cancer care results in pain, fever, delay in treatment, additional hospitalizations, and increased cost to families/significant others and the health care system which, in turn, impacts the public at large (Carrillo, Vizeu, Soares-Junior, Fava, & Filho, 2010; da Fonesca, 2004).

Methods: A Clinical Microsystems approach was used to ensure successful implementation of the project conducted by the DNP (PNP) student. She collaborated with members of a university dental school and the leadership of the major urban outpatient pediatric oncology cancer center and IRB to gain approval to implement her educational project for the pediatric oncology providers (pediatric oncology MDs, NPs, RNs) at the cancer center. The participants: (a) completed a pre-survey assessing their oral systemic health knowledge, current oral health practice, perceived barriers to dental referral and attitudes toward incorporating preventive oral health care into their oncology practice, and (b) attended an oral health educational intervention and fluoride varnish skills lab conducted by the DNP candidate (PNP), dental residents and dental fellows where they learned how to perform an oral assessment to detect the existence of carries, make a referral for caries if identified, and how to apply fluoride varnish on children who were to be treated for cancer. Participant knowledge and skills were assessed after the educational program and chart data indicated whether these new competencies were used with the pediatric population. A one year follow-up survey was instituted.

Results: The results of this innovative capstone project indicated that pediatric oncology providers were in a unique position to provide preventive oral health care and improve oral health outcomes in pediatric cancer patients. The educational program increased their oral health knowledge of the providers; a review of chart data indicated that children who came to the cancer center were now receiving oral health assessments, had fluoride varnish as needed, and referrals were being made as needed. In this center only children who were seen by a dental resident once a week had ever received this standard of care. Prior to this project none of the oncology providers (MDs, NPs, RNs) had included this in their practice. At the end of the projects, data indicated that children being treated by oncology providers, who participated in this project, had increased from zero to 100%. This educational program was adopted as a standard of practice at the center and all providers complete this oral health program. Fluoride varnish is now on the standard formulary; all pediatric patients receive this gold standard of oral health care prior to treatment. One-year follow up survey data indicate that this practice continues to be implemented by all providers. The improvement on care delivery demonstrated in this project may be replicated in other settings and serves as a model for pediatric oncology clinics across the country. Feedback from invited as well as competitive presentations at local, regional, and national interprofessional conferences, as well as quality improvement data provide evidence that this clinical project is realistic and can be easily replicated in other settings. Currently, it is being implemented on the in-patient unit at this major medical center.

Implications for Practice, Education, and Policy: The project has several implications for practice. DNP prepared advanced nursing practice NPs need to assume a clinical leadership role and instruct other providers regarding evidence-based standards of care that need to be instituted. Specifically DNP prepared PNPs must assume the role of educating health care providers who care for both well and chronically ill children to include oral health care in acute and chronic healthcare settings and schools. This project also has important implications for pediatric cancer survivors who may develop late effects from their cancer treatment that will require dental care. Interprofessional education and practice collaboration between medical, nursing, and dental providers must become an integral part of health care delivery systems. The implications for education of DNP programs that prepare NPs is that DNP graduates must obtain clinical leadership competencies that include: (a) use of an appropriate implementation framework, (b) the ability to critically appraise and synthesize the best available evidence in order to change the practice of health care providers, (b) making recommendations and creating policies based on the best appraised evidence, and (d) teaching oral health competencies and best practices as part of the standard of care regardless of the population. It further highlights the need for all health care provides to receive oral-systemic health care knowledge and related competencies during their education. The specific implications for policy are at the institutional practice setting level. When successful results are obtained from evidence-based clinical improvement projects, such as Dr. Hartnett’s, these practices will be sustained when they demonstrate positive clinical outcomes and become the expected gold standard policy.

Vicky Grossman , Duke University

Carrie Kairys , Johns Hopkins University

Contact Information

Please direct any questions related to this awards program to [email protected] .

Congratulations to the 2023 Award Recipients!

Ruth Tretter , PhD, RN Idaho State University (PhD  Exploring RV-dwelling American Nomads’ Experiences When Seeking Healthcare Program Director - Mary A. Nies

Christina Jones , DNP, PMHNP Arizona State University  Teen Mental Health Literacy: A School District’s Post-Pandemic Response Program Director - Diane Nunez

Amber High , DNP, CRNA University of Texas Medical Branch  A Novel Peer Support Project: Quality Improvement for Workforce Well-being Program Director - Sharron Forest

Dissertations and DNP Projects

The Doctor of Philosophy (PhD) dissertation embodies the highest level of knowledge to influence and improve nursing science and the profession through various types of studies using quantitative, qualitative, or mixed methods. A hallmark of doctoral research training, the PhD dissertation focuses on the knowledge and skills needed to conduct rigorous studies that extend the body of nursing knowledge; address important health care issues; and improve health outcomes, equity, and inclusion, all while informing health policy.

A PhD dissertation, grounded in the philosophy of science and a PhD candidate’s expertise, represents a standard of excellence and the candidate’s ability to conduct rigorous research. A PhD dissertation at UMSON contributes to the advancement of nursing/health science, solves important health care issues, and informs stakeholders. Nursing research is critical to the nursing discipline and is necessary for building evidence for practice that promotes optimal nursing care.

View the List of PhD Dissertations

The Doctor of Nursing Practice (DNP) project embodies the highest level of knowledge in nursing practice. Influencing health care outcomes through leadership, policy, information technology, systems change, and patient-centered care, the DNP project focuses on translating science into clinical practice and the delivery of patient-centered and/or population-based care.

A DNP project’s collaborative and integrative experiences reflect the development and provision of safe, effective, timely, efficient, equitable, and person-centered care aimed at advancing health outcomes. The impact of UMSON DNP projects will reshape health care in the United States.

View the List of DNP Projects

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Chun Shen wins 2016 APS DNP Dissertation Award

Chun Shen, who received his Ph.D. from Ohio State University in August 2014, working under the guidance of Prof. Ulrich Heinz, has been awarded the 2016 Dissertation Award of the Division of Nuclear Physics (DNP) of the American Physical Society  for his thesis "The standard model for relativistic heavy-ion collisions and electromagnetic tomography,"( http://www.aps.org/programs/honors/prizes/prizerecipient.cfm?last_nm=Shen&first_nm=Chun&year=2016 ). One such award is given each year; it consists of $2,500 and an allowance for travel to the 2015 DNP Fall Meeting in Santa Fe, where he will talk about his work and the award will be presented. The citation for the award reads ”For his successful prediction of anisotropic flow in Pb+Pb collisions at the LHC, his elucidation of the `direct photon flow puzzle', and his contributions to the development of a computational tool of viscous fluid dynamics enabling precision studies of relativistic heavy-ion collisions.”  According to the chair of the selection committee, “the committee had a difficult job making the selection, given the large number of impressive nominees. Chun Shen’s dissertation and impact were judged to be outstanding.” 

Chun Shen is presently a Postdoctoral Fellow at McGill University where he uses the theoretical framework developed in his PhD thesis to extract the transport property of the QGP, namely shear and bulk viscosities and the heat conductivity, to understand the underlying many-body interactions in strongly interacting matter at extreme temperature and density. He was previously awarded the  Elizabeth Clay Howald Presidential Fellowship  of The Ohio State University (2013), the  Chinese National Award for Outstanding Ph.D. Students Abroad  (2014), and received an honorable mention from Brookhaven National Laboratory in the 2015 RHIC and AGS Thesis Award competition. His advisor, Prof. Heinz, proudly notes that this is already the second APS DNP Dissertation Award given to one of his protégées, after his student Huichao Song won this award in 2011. Go Bucks!

DNP Dissertation Award Committee

Chair: Haiyan Gao , Duke Member & Past DNP Chair: S. Victoria Greene, Vanderbilt U. Members:

• Michael Kohl, Hampton U.
• Tim Chupp, U. Michigan
• Matthew Green, NC State
• Zhongbo Kang, UCLA

Chair: S. Victoria Greene, Vanderbilt U. Past DNP Chair: Sherry Yennello, Texas A&M U. Members:

• Julie Roche, Ohio U.
• Rebecca Surman, Notre Dame U.

Chair: Sherry Yennello, Texas A&M University Past DNP Chair: Krishna Kumar, UMass Amherst Members:

• Mohammad Ahmed, North Carolina State University
• Martha Constantinou, Temple University
• Julie Roche, Ohio University
• Richard Furnstahl, Ohio State University

Chair: Krishna S. Kumar, University of Massachusetts Amherst Past DNP Chair: Robert V. F. Janssens, University of North Carolina Members:

• Latifa Elouadrhiri, Jefferson Lab
• Mike Lisa, Ohio State University

Chair: Robert V. F. Janssens, University of North Carolina Past DNP Chair: David J. Dean, Oak Ridge National Laboratory Members:

• Philip S. Barbeau, Duke University
• Senta Victoria Greene, Vanderbilt University
• Latifa Elouadrhiri, Jefferson Laboratory

Chair: David J. Dean, Oak Ridge National Laboratory Past DNP Chair: John F. Wilkerson, University of North Carolina Members:

• James P. Vary, Iowa State University
• Lee G. Sobotka, Washington University

Chair: Michael Thoennessen, Michigan State University Past DNP Chair: Gordon Cates, University of Virginia Members:

• Christopher Crawford, University of Kentucky
• Yury Kolomensky, UC Berkeley

Chair: Gordon D. Cates, University of Virginia Past DNP Chair: John F. Wilkerson, University of North Carolina Members:

• Philippe A. Collon, University of Notre Dame
• Bruce R. Barrett, University of Arizona
• Ulrich Heinz, Ohio State University

Chair: John F. Wilkerson,  University of Washington Past DNP Chair: Ani Aprahamian, University of Notre Dame Members:

• Bradley M. Sherrill, Michigan State University
• Philippe Collon, University of Notre Dame
• Bradley W. Filippone, California Institute of Technology

Chair: Ani Aprahamian, University of Notre Dame Past DNP Chair: Berndt Mueller, Brookhaven National Laboratory Members:

• Douglas H. Beck, University of Illinois
• Allena K. Opper, George Washington University

Chair: Berndt Mueller, Duke University Past DNP Chair: Robert D. McKeown, Jefferson Laboratory Members:

• Alexandra Gade, Michigan State University
• Charles J. Horowitz, Indiana University

Chair: Robert D. McKeown, Jefferson Laboratory Past DNP Chair: Robert E. Tribble, Texas A&M University Members:

• Daniel R. Phillips, Ohio University

Chair: Robert E. Tribble, Texas A&M University Members:

• William A. Zajc, Columbia University
• Paulo Bedaque, University of Maryland
• Ulrich W. Heinz, Ohio State University
• Gerald A. Miller, University of Washington

Chair: William A. Zajc, Columbia University Members:

• Lawrence S. Cardman, Jefferson Laboratory
• Saskia Mioduszewski, Texas A&M University
• Sam Tabor, Florida State University

Chair: Lawrence S. Cardman, Jefferson Laboratory Members:

• Richard F. Casten, Yale University
• T.W. Donnelly, Massachusetts Institute of Technology
• David Hertzog, University of Illinois

Chair: Richard F. Casten, Yale University Past Chair: Richard G. Milner, Massachusetts Institute of Technology Members:

• R.J. Holt, University of Illinois
• Winston Roberts, Florida State University

Chair: Richard G. Milner, Chair, Massachusetts Institute of Technology Past Chair: Susan J. Seestrom, Past Chair, Los Alamos National Laboratory Members:

• Gail McLaughlin, North Carolina State University
• John F. Wilkerson, University of Washington

Chair: Susan J. Seestrom, Los Alamos National Laboratory Past Chair: Bradley M. Sherrill, Michigan State University Members:

• Barbara V. Jacak, SUNY Stony Brook
• Madappa Prakash, Ohio University

Chair: Bradley M. Sherrill, Michigan State University Past Chair: Donald F. Geesaman, Argonne National Laboratory Members:

• Thomas D. Cohen, University of Maryland

Chair: Donald F. Geesaman, Chair, Argonne National Laboratory Vice Chair: A. Baha Balantekin, Vice-Chair, University of Wisconsin Members:

• Haiyan Gao, Duke University
• R.G. Hamish Robertson, University of Washington

Chair: A. Baha Balantekin, University of Wisconsin Members:

• Charles Glashausser, Rutgers University
• Charles Horowitz, Indiana University
• Michael Savage, University of Washington

Chair: Charles Glashausser, Rutgers University Members:

• Joel M. Moss, Los Alamos National Laboratory
• Witek Nazarewicz, University of Tennessee
• P. Parker, Yale University
• Gerald A. Peterson, University of Massachusetts

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A Nurse's Step-By-Step Guide to Publishing a Dissertation or DNP Project

Early praise for  a nurse's step-by-step guide to publishing a dissertation or dnp project :.

“The book breaks down the complexities of scholarly writing and provides key insight and vital guidance for publishing dissertations or DNP projects. A Nurse’s Step-By-Step Guide to Publishing a Dissertation or DNP Project will have a permanent place on my bookshelf and will be shared with new graduates and colleagues alike .”

— Nancy White Street, ScD, PPCNP-BC Julia and Harold Plotnick Professor of Global Nursing University of Massachusetts Dartmouth College of Nursing

“Karen Roush’s earlier book on writing a dissertation or scholarly project has become the ‘go-to’ resource for scores of doctoral students. In her new book, Roush has again demonstrated her unique knack for simplifying a process—the often-arduous steps necessary for turning a dissertation or capstone project into a manuscript worthy of publication. A must-read primer for anyone wanting to publish.”

— Wend y Budin, PhD, RN-BC, FAAN Professor & Associate Dean Entry to Baccalaureate Practice Division Editor-in-Chief, Journal of Perinatal Education Rutgers, The State University of New Jersey School of Nursing

INDIANAPOLIS — Creating a dissertation or academic project is a demanding and complicated process, presenting a unique set of challenges for authors. Navigating the publishing process presents further challenges. Creating the best article and finding the most appropriate journals often leaves first-time authors frustrated and intimidated.

In A Nurse’s Step-By-Step Guide to Publishing a Dissertation or DNP Project , award-winning author Karen Roush guides readers through the process of reworking a dissertation or DNP project into a high-quality manuscript and honing their writing skills. Roush then provides a step-by-step guide through the publication process, providing all the information necessary to fully understand and navigate the world of academic publishing.

“The full breadth and depth of nurses’ contributions are still not recognized by the healthcare community and the general public,” said Roush. “Publication is a powerful means of strengthening the voice of nursing and influencing how care is delivered.”

The author has also created material downloads, such as a Submission Checklist and a Top 10 Guide to Publishing, to support the use of this book in classroom and professional settings. These downloads are available for free at http://hdl.handle.net/10755/17097 .

This book is available at SigmaMarketplace.org/sigmabooks .

A Nurse’s Step-By-Step Guide to Publishing a Dissertation or DNP Project: Taking Your Paper From Graduation to Publication By Karen Roush, PhD, RN, FNP-BC Published by Sigma, 2019 ISBN-13: 9781948057370 EPUB ISBN: 9781948057387 PDF ISBN: 9781948057394 MOBI ISBN: 9781948057400 Price: US $39.95 Trade paperback, 208 pages Trim size: 5 3/8 x 8 3/8

About the author: Karen Roush, PhD, RN, FNP-BC, is founder of The Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses. A previous Editorial Director and Clinical Managing Editor for American Journal of Nursing, Roush is widely published, having authored multiple consumer healthcare books, nursing articles in peer-reviewed journals, essays, and poetry. She is also adjunct faculty at Pace University and The Graduate Center for the City University of New York.

About Sigma: The Sigma Theta Tau International Honor Society of Nursing (Sigma) is a nonprofit organization whose mission is advancing world health and celebrating nursing excellence in scholarship, leadership, and service. Founded in 1922, Sigma has more than 135,000 active members in over 100 countries and territories. Members include practicing nurses, instructors, researchers, policymakers, entrepreneurs, and others. Sigma’s more than 540 chapters are located at more than 700 institutions of higher education throughout Armenia, Australia, Botswana, Brazil, Canada, Colombia, England, Eswatini, Ghana, Hong Kong, Ireland, Israel, Jamaica, Japan, Jordan, Kenya, Lebanon, Malawi, Mexico, the Netherlands, Nigeria, Pakistan, Philippines, Portugal, Puerto Rico, Scotland, Singapore, South Africa, South Korea, Sweden, Taiwan, Tanzania, Thailand, the United States, and Wales.

Learn more at www.SigmaNursing.org .

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Home > ETDs > DNP Projects

Doctor of Nursing Practice (DNP) Projects

Dnp projects from 2023 2023.

Implementing an African American Cultural Awareness Program for Skilled Nursing Facility Staff , ADEKEMI T. ADEDIPE

Community Health Worker Certification Program - Motivational Interview, Advocacy, Communication and Conflict Resolution , Stella Antony

Predicting the Risk of Falling with Artificial Intelligence , Ann Aquino

Mindfulness Based Self Care Toolkit for Psychiatric Healthcare Staff , Harkirat K. Bajwa

Mindfulness Based Self Care Toolkit for Psychiatric Healthcare Staff , Harkirat Kaur Bajwa

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

Improving Patient Safety for Surgical Clearance: A PreOp One Stop Shop , Anna Benedictos

Using Critical Incident Debriefing after Code Blue Events to Support Registered Nurses , David L. Boyd

Improving New Nurse Manager Orientation and Onboarding Program , Leanne E. Deegenaars

Effects of Leadership Education and Mentoring for Assistant Nurse Managers , Karen T. Descent

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

Supporting Mental Health in Children by Providing Basic Skills and Knowledge of Mental Health to Middle-School Teachers , MariaElena Falcon

Reducing 30-day Heart Failure Hospital Readmissions Through the Implementation of a Telehealth Education and Screening Program , Madison Geib, Jo Loomis, and Maria (Dupi) Gomez Cogan

Responding to a Deteriorating Patient: An Educational Intervention for Outpatient Clinic Nurses , Angela N. Ikeme

Screening for Uterine Fibroids in Black Women , Winnie N. Kagendo

School-Based Development and Implementation of Adolescent Mental Health Educational Toolkits , Chantel M. Kilford Ms

School-Based Development and Implementation of an Educational Toolkit , Chantel M. Kilford Ms

Assuring a Continuum of Care for Heart Failure Patients Through Post-Acute Care Collaboration , Purnima Krishna

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

Educating Community Health Workers and Gatekeepers to Screen for Suicide , Jennifer Maina

The importance of suicide screening training for healthcare providers as part of suicide prevention , Jennifer Maina

Mental Health Services: Reaching the Homeless , Gurdeep Mann

Improving Outcomes in Persons Who Inject Drugs: A Multidisciplinary Healthcare Initiative , Carla S. Martin

Implementation of a Community Health Worker (CHW) training program to improve birth outcomes , Emiko Maruri

Beyond the Physical Wounds: A Proactive Approach to Mental Health Recovery After a Traumatic Injury , Christine McGahey

Environmental and Occupational Health Risks: Educating Undergraduate (ADN-BSN) Nursing Students for Safer Practice , Dorinda A. Mercado

Enhancing Mental Health Assessments for Hysterectomy Patients: Implementing a Depression Screening Tool for Healthcare Clinicians , Dede Mihedji

Depression Screening Tool for Hysterectomy Patients , Dede C. Mihedji

Developing and Implementing an Infection Prevention Practice Fellowship Program , Sejal Naik

Implementing Community Health Workers to Improve the Management of Chronic Non-Communicable Diseases in Children , Julia L. Newell

Implementing an Infant-Driven Feeding Practice Model , Ann P. Nguyen

Reducing 30-Day Psychiatric Inpatient Hospital Readmission of Mentally Ill Homeless Men with Substance Use Disorder by Using a Discharge Checklist , Chibuogwu E. Ogbuka

A Quality Improvement Project on Anxiety Management Before Ketamine-Assisted Psychotherapy , Kiera Paulo

Enhancing Nurse Manager Resilience with a Resilience-Enhancing Toolkit , Rosarina A. J. Pelikan

Strategies to Reduce Chronic Disease: Adding Role to Community Health Workers , Ingrid J. Renwanz DNP, PMHFNP-BC/APRN, MSN, RNC

Community Health Worker Program: Adverse Childhood Experiences and Early Childhood , Arelis Sandoval

Implicit Bias in Nursing: Raising Awareness, Fostering Change , Jeanette C. Sandoval

Determining Care Delivery Model Feasibility Using Discrete-Event-Simulation , Tanya Scott

Implementation of Implicit Bias Training in a Doctor of Nurse Practitioner Program , MacDana Selecon

Improving Health Outcomes for LGBTQ+ Youth Through Provider Education , Marissa Simko

Implementation of Fast-Track Triage Process to Improve Ambulance Patient Offloading Time (APOT) in a Psychiatric Emergency Services (PES) Unit , OKE AUGUSTINE UMEUGOJI

Improving Health Outcomes Among Patients with CHF Through Implementation of Telehealth Depression Screening and CHF Symptom Management , Akudo Udodiri Unanwa

The Dedicated Education Unit: Increasing Capacity and Confidence , Heather Marie Van Housen

DNP Projects from 2022 2022

Save the Children Community Health Worker Program—Project Management , Lauren Loree Burchfield

Increasing vaccination rates in the Latin X communities through a public health initiative for increasing education and vaccination , Gabriela Carrico

Educating Providers Without Prescriptive Authority About Psychopharmacology Basics: Bridging the Interdisciplinary Work Among Psychotropic Prescribers and Psychologists , Olivia Ceja

Psychosocial Distress Screening for Patients with Cancer: A Value-Based Approach to the Integration and Delivery of Holistic Care , Candy Cheung

Engaging Rural Providers About the Potential of Low-Earth Orbit Internet Satellite Supported Rural Telehealth Programs , Joshua M. Cleary

Development and Implementation of a Standardized Protocol for Nurse Practitioners Working in an AUD Treatment Telehealth Program , CJ Dea

Oleoresin Capsicum Gel: Enhancing Safety for the Home Health Clinician , Lilly Dickens

Diabetes Prevention and Management Education for Punjabi-Sikh Older Adults , Mandeep K. Gill

Improving Home Health Nurses' Knowledge of Heart Failure Self-Care Management , Nenette Hoffman

Improving Colorectal Cancer Screening in Primary Care , Bushra iqbal

Improving Colorectal Cancer Screening in Primary Care , Bushra Iqbal

Community Health Worker Program - Substance Use Disorder in Pregnancy , Alicia Claire Kletter DNP

Improving Diabetes Self-Management (DSM) Among Patients with Uncontrolled Type 2 Diabetes Mellitus (T2DM): A Patient-Centered Education Model , Maria Hannah Tiangha Mandecote

Save the Children® Community Health Worker Program - Prenatal Care , Deirdre A. Martinez

MITIGATE Toolkit for Outpatient Antibiotic Stewardship: Enhancing Safe Antibiotic Prescribing Practices , Allyssa Marie Montemayor and Allyssa Marie Montemayor

Implementing a Diabetic Foot Care Program in a Virtual Primary Care Clinic , Zahra Naderi Asiabar

Decreasing Seclusion and Restraint Events Among Clients Within an Inpatient and Crisis Stabilization Behavioral Health Facility , Karen Lee Richards

Utilization of the Nurse Practitioner Skillset in Partnership with the Medical Device Industry , Daniel C. Rowland

Integrating Culturally Tailored Interventions to Increase Cervical Cancer Screening: A Quality Improvement Initiative in a Primary Care Clinic , Marife Centeno Solomon

Advancing Treatment for Opioid Use Disorder in a Rural Emergency Department , Jill M. Wabbel

DNP Projects from 2021 2021

Technology-Based Advance Care Planning Education for Primary Care Patients , Taryn Achong

Development and Implementation of an Evidence-Based Practice Mentor Fellowship , Stacy L. Alves

Promoting Antibiotic Stewardship in Primary Care Setting: An Evaluation Process of Treatment Practices for Uncomplicated Urinary Tract Infections in Premenopausal Non-Pregnant Women , Ira Amayun

Manager Onboarding to Improve Retention, Knowledge, and Confidence to Lead , Christine Asiimwe

Manager Onboarding to Improve Knowledge and Confidence to Lead , Christine (Tina) K. Asiimwe

Designing and Implementing a De-Escalation Toolkit to Improve Staff Education and Competency on De-Escalation within a Mental Health Outpatient Setting , Balraj Bajwa

Increasing Chlamydia Screening in the High-Risk Population using Electronic Notification and Targeted Education: A Primary Care Approach , Michael Barnett

Transcatheter Aortic Valve Replacement: Implementation of Shared Decision-Making , LIESEL BUCHNER

Mindfulness-based Cognitive Therapy Staff Training Program to Tackle Postpartum Depression , Helen XUMIN Chen

Implementation of an Acute Care for the Elderly (ACE) Unit in a Community Hospital , Kimberly A. Colonnelli

Bullying in the C-Suite: A Nurse Leader Perspective , Kimberly Ann Colonnelli

Educating Providers to Screen for Post-Traumatic Stress Disorder , Alyssa Fraino

Creating a Pipeline to Increase Diversity in Executive Leadership Positions , Trarina Harris

Developing a Culturally Relevant Mental Health Assessment for Persons of African Descent , Roberta Iyamu

A Peer Feedback Process to Improve Assistant Nurse Manager Job Satisfaction , Juanita A. Jularbal-Walton

Development of an eHealth Harm Reduction Resource to Address Opioid Use Among Youth in Rural Northern California , Carolyn Perrotti Lake

Implementation of a Mental Health Environmental Risk Assessment Tool , Alan Le

Purposeful Nurse Hourly Rounding: A Plan To Decrease Patient Falls During a Pandemic , Robbie Masangkay

Purposeful Nurse Hourly Rounding: Plan to Decrease Patient Falls During a Pandemic , ROBBIE MASANGKAY

Regulatory Orientation to Support Transition to Academic Leadership , Annmarie Munana

Preparing Nurses in Management Positions for Bedside Care During Times of Crisis , Trevor Murray

Utilizing Digital Technology to Address Loneliness and Isolation in Older Adults through a Community-Based Connection Model: Responding to a Pandemic , Melissa A. Nagel

The Nurse Will See You Now: Improving Nurse-Led Chemotherapy Teaching , Laura Oka

PROVIDING HYPERTENSION EDUCATION FOR AFRICAN IMMIGRANTS AT A SOUTHERN CALIFORNIA CONGREGATION DURING THE COVID-19 PANDEMIC , Esther Oshunluyi

PROVIDING HYPERTENSION EDUCATION TO AFRICAN IMMIGRANTS AT A SOUTHERN CALIFORNIA CONGREGATION DURING THE COVID-19 PANDEMIC , Esther Oshunluyi

Increasing Continuous Positive Airway Pressure Compliance with Various Telemedicine Interventions: An Integrated Literature Review , Tracy Partington

Telehealth Appointments to Increase Therapy Compliance in Patients with MOSA , Tracy J. Partington

Behavioral Health Patients and Agitation in the Emergency Department: A Synthesis of Literature , Adam Pelzl

Implementation of an Agitation Scale in Three Emergency Departments in an Urban Area of Northern California , Adam Pelzl

Targeting Pre-Operative Booking Processes to Decrease Risks of "Never Events" , Rebecca Lynn Poths and Rebecca Lynn Poths

Building Excellence through Shared Governance and Continuous Process Improvement , Deborah Reitter

Streamlining Care for Children with Autism Spectrum Disorder , Siavash Rostami Jafarabad

Nurse Practitioner-Led Care Pods: A Team Communication Enhancement Model , Miranda Saint-Louis and Miranda Saint Louis

Use of Simulation to Improve Nurse's Response to COVID-19 Code Blue: A Literature Review , Charity Shelton

Using Simulation to Improve COVID-19 Code Blue Outcomes , Charity Shelton

Utilizing Group Prenatal Care to Support Underserved Pregnant Women , Kathleen Shrader

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Home > School of Nursing and Health Science > Doctor of Nursing Practice Final Manuscripts

Doctor of Nursing Practice Final Manuscripts

Dnp final manuscripts from 2023 2023.

The Impact of the Family Nutrition and Physical Activity (FNPA) Tool with Diet and Physical Education on Obesity Awareness and Body Mass Index (BMI) of Overweight Patients , Sheena Amos

Measuring The Effectiveness of Antidepressant Treatment By Implementing Beck's Depression Inventory (BDI) , Azeem Anjum

Increasing Utilization of IVC POCUS for Patients with Sepsis , Alexis Arreola

Improving Care for Children and Adolescents with Down Syndrome in the Military Health System , Katherine B. Arrogante

Better Sleep, Brighter Mornings: A Sleep Hygiene Protocol for Older Adults as a Quality-of-Life Enhancement , Melissa Baltazar

Evaluation of Depression Screening Frequency in the Geriatric Population: A Pilot Project , Neha Bhagat

Implementation of an Evidenced Based Peripheral Artery Disease Screening Protocol in an Outpatient Internal Medicine Clinic , Sarah Lee Bolanos

Implementation of the American Diabetes Association Pharmacological Approach for Adults with Type 2 Diabetes Mellitus with Cardiovascular Disease , Jose Cedillo

Mental Health Wellness in the Latino Population: Improving PHQ-9 scores in Depressed Patients with Comorbid Type II Diabetes , Amanda Cuellar

Decreasing Weight Bias Among APRNs, APRN Students, and RN Nursing Students Through Educational Seminars , Apryl Cutler

Implementation of Clinical Institute Withdrawal Assessment: Alcohol Revised (CIWA-Ar) Education Program in a Crisis Stabilization Unit , Amanda Dehart

Advocating for Nurse Practitioner Independent Practice , Tamara Troyer Denlinger

Talking with Horses: Equine Assisted Activities to Promote Social Engagement in Individuals with Autism Spectrum Disorder , Amy Ezhaya

Improving Nursing Student Retention: Early Identification of Determinants Causing Attrition in Nursing Academic Programs , Tennille Gifford

Are You in Control of Your Diabetes? Providing 1:1 Diabetic Self-Management Education to Adults With Type II Diabetes Mellitus in an Outpatient Clinic in an Underserved Community , Joe Gonzales

Feasibility of Family Focused Obesity Screening in Primary Care , Adrianne Griffiths

3D-Wound Imaging: Precise, Consistent, and Efficient , Aubrey Halili

Be Kind to Your Mind: The Use of Mobile Based Applications to Reduce Stress and Improve Health Outcomes , Akira Hanson Finn

Implementation of the Diet Readiness Test to Assess Self-Efficacy and Education Effectiveness in Overweight Women , Tatjana Ilich

Implementation of the Generalized Anxiety Disorder 2-Item Screening Tool for Adult Patients in an Underserved Outpatient Cardiology Clinic , Leila Joint

Managing Menopausal Symptoms Through Exercise and Dietary Changes , Ae rah Kang

Implementation of a Follow-Up Procedure for Patients Treated with Transcranial Magnetic Stimulation at a Primary Care Clinic , Brooke Marino

Improving nurse call by evaluating a new technology , Ariel Norton

Reducing Polypharmacy amongst home based older adults using patient centered education , Evelyn Oluoha

Assessing Genomic Literacy in Advanced Practice Nursing Students Before and After an Intervention , Guiselle Palomera

Nurse-Led Post Stroke Depression Screening (PSD) for Patients with Acute Stroke Using Patient Health Questionnaire-9 (PHQ9) , Stefan Panov

Utilization of Telemedicine for Follow Up Appointments in Radiation Oncology , Priya Patel

Educating and Improving Collegiate Athlete Sunscreen Use , Julia Pederson

Implementation of the Columbia-Suicide Severity Rating Scale at an Outpatient Mental Health Practice to Increase Provider Confidence in Identifying Suicide Risk , Lauren Reed

Church-Based Hypertension Education: An Alternative Solution to Hypertension Management in the African American Community , Nicole Tofi Rice

Exercise As a Prescription for Patients with Depressive Disorders: A Quality Improvement Project , Sydney Roscoe and Rachelle Pace

Implementing Outpatient Screening of Adult Patients at High Risk for Peripheral Artery Disease , Coral Roseberry

Improve Hypertensive Patients’ Compliance Postgraduation from the Virtual Care Team Program , Marcie Santillan

A COMPARISON OF SUPRATHEL BURN DRESSING VS STANDARD CARE ON LENGTH OF HOSPITALIZATION, PAIN SCORES, OPIOID USE, TREATMENTS, AND OUTCOMES. , Rakiema T. Sellars-Pompey and Anthonia Okoh

A Prescription for Exercise in Adolescents: A Pilot Project , Alexa Sikalis

Improving Access to Colorectal Cancer Screening in Latino Communities in California: Eliminating Transition to Practice Hours for Nurse Practitioner Full Practice Authority , June Spilburg

The Future of Cognitive Dysfunction in Elderly Patients: A Clinical Perspective with Recommendations , Laura Taylor

Improving Patient Self-Efficacy, Readiness, and Completion of Advance Care Planning Documents Using PREPARE Documents and Advance Care Planning Group Referral , Marie Vassiliadis

Implementation of a Shared-Decision Making (SDM) Approach in a Community Based Outpatient Mental Health Clinic , Alexa Vuylsteke

Fostering Resilience in Children of United States Navy SEALs Using a Social Media Platform , Riley Walker

A Pilot Project for Tuberculosis Education in College Students , Sarah Williams

DNP Final Manuscripts from 2022 2022

Improved Monitoring of Depression and Suicidal Ideation in Low-Income Adolescents through Evidenced Based Provider Education , Sunday Adeyeye

Increasing Mental Health Literacy in the Black Church , Jonathan Allotey

Implementing Adverse Childhood Experience Screening in an Intensive Outpatient Mental Health Program , Bryan Amaro

Impact of Telephonic Follow Up in Patients Initiating Antineoplastic Treatment in the Ambulatory Setting , Lauren Belkin

Forestalling: Decreasing Super-Utilizers in the Emergency Department Using Case Management Strategies , Kelly Chambers, Megan Gilmartin, and Martha Narasimhan-Narayanan

eConsent Forms on Ancillary Applications with Electronic Medical Record Integration – Reducing Consent Error , Lilian Chan

Increasing COVID-19 Vaccine Awareness Among Hispanic Families: A Policy Perspective , Allison Chico, Iris Vazquez, Claudia Aguayo, and Jose Andres Rozo

Improving Completion Rate of Identifying Seniors At Risk (ISAR) Screening Tool in Emergency Department (ED) Setting , Ashley Clark

Improving Same Day Surgery Patient Outcomes Through a Nurse Practitioner Led Telephone Follow-up Call , Jessica Cooke and Kamila Zasowska

Does Comfort Care Make You Uncomfortable? Use of the CARES Tool for End-of-Life Symptom Assessment and Management , Christina Covington

Effects of Telephone Follow-up on Medication Adherence and Rapid Readmission Among Discharged Adults With Schizophrenia Spectrum Disorders (SSDs) , Romilynn Danko and Madalyn Cosensci

Implementation of the blunt tip cannula for dermal fillers to decrease adverse events intra and post treatment , Natalie Drone

Fall Risk Assessment and Intervention to Reduce Fall-Related Injuries and Hospitalization in Older Adults , Pittawat Emerson

Improving Discharge Outcomes: Telephone Follow Up for Heart Failure Patients , Ashley Fanjoy

Enriching the Perioperative Enhanced Recovery After Surgery (ERAS) Program for Patients Undergoing Whipple Procedure for Pancreatic Cancer , Natalie E. Fisher

Decreasing Falls on a Locked Inpatient Psychiatric Unit , Terri Fitzpatrick

Identifying Elderly Patients at High Risk for Post-Operative Cognitive Dysfunction: A Clinical Perspective , Kelly Glas

Effects of Diabetes Self-Management Education in the Primary Care Setting on Self-Efficacy and Glycosylated Hemoglobin Levels Among Adults With Type 2 Diabetes Mellitus , Colleen Harris

Physician Orders for Life-Sustaining Treatment (POLST) Forms in a Primary Care Setting , Elena Johns

Evaluating the Effectiveness of Education on the Misuse of Corticosteroids and Antibiotics for Treatment of Acute Pharyngitis , Samantha Kaikai

Screening for childbirth-related posttraumatic stress disorder using the City Birth Trauma Scale: A pilot project , Meredith Kazato

Improving Vaccination Rates Through Community Partnership , Marissa Marquez

Prediabetes education to prevent the progression to type 2 diabetes , Peggy Mata

The Power of Proactive Referrals: An Evidence-Based Practice Project to Improve Smoking Cessation Rates at a Community Health Clinic , Kristin McMahon

Screening for Suicide Risk in the Outpatient Electroconvulsive Therapy Population , Cerah Nagata

LIFESTYLE MODIFICATION INTERVENTIONS ON HEMOGLOBIN A1c LEVEL IN PATIENTS WITH TYPE II DIABETES MELLITUS IN AN UNDERSERVED COMMUNITY: A PILOT PROJECT , Anniesatu Newland

Implementation of Nola Pender’s “Clinical Assessment for Health Promotion Plan” to Increase Patient Self-Efficacy, Weight Loss and Health Promoting Behaviors Such as Improving Nutrition and Increased Physical Activity in Obese Women in a Weight Loss Clinic , Christine Ngwazini

Implementation of the Edinburgh Postpartum Depression Screening Tool to Screen Mothers for Postpartum Depression in the Pediatric Setting , Vera Nikolaychuk

Treatment Evaluation of Iron Deficiency Anemia in Women of an Underserved Community , Bukola Olusanya

Implementation of Surgical Education Video to Burn Patients Before the Informed Consent Process , Brian Piatkowski

Development of a Nurse Practitioner Driven Program for Cardiology Providers to Increase Knowledge and Awareness of Neurodevelopmental Assessment Needs in Children with Congenital Heart Defects , Michele Readman

Smiling Mind: A Mobile Based Application to Reduce Stress , Agnes Rodrigues

The Use of Telehealth to Improve Patient Outcomes Among Prediabetes and Diabetic Patients in a Rural Women's Health Clinic: An Evidence-Based Practice Project , Alejandra Villegas

National Early Warning Score (NEWS) for COVID-19 infected Patients: A Clinical Guidance Tool , Robert Villegas

Screening People Experiencing Homelessness for Adverse Childhood Events (ACEs) , Priya Vishwanath

DNP Final Manuscripts from 2021 2021

Identifying Adverse Childhood Experiences (ACEs) in a Federally Qualified Health Center using the Pediatric ACEs and Related Life Events Screener , Melody Albarran-Slovin, BSN, RN

Telehealth Breastfeeding: Best Practice Guideline , Laura Amabile

Obesity Prevention Toolkit to Combat Weight Gain Related to Sedentary Behavior and Dietary Habits in College Students: An Evidence-Based Project , Maria Amos and Martha Fuller

Motivational Interviewing and Frequent Follow-up in a Pediatric Primary Care Setting to Improve Diet and Activity in Adolescents , Celeste Armenta and Kathy James

Addressing Vaccine Hesitancy with Motivational Interviewing: A Pilot Study , Olivia Ball

A Guide to Vaccine Policy Change at a National Level , Janelle Bird

Sunscreen Use and Screening in College Athletes: An Evidence-Based Pilot Project , Nicole Brustkern BSN, RN, CPN and Sharon Boothe-Kepple PhD, MSN, FNP-C, PHN (Chickasaw)

Implementing EBP Guidelines to Optimize Human Donor Milk Usage in the Hospital Setting , Kimberly Carriker

Bridging the Gap: Utilization of Telehealth for Heart Failure Patients to Reduce Hospital Readmissions: Best Practice and Recommendations , Shalaine Corbilla

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project , Alison Cusmano

Preoperative Fasting Policy Updated for Healthy Patients , Janet Dewees

Improving Identification of Seniors at Risk Tool Adherence to Identify Emergency Department Readmissions in Older Adults , Joy Gao

Impact of Psychotropic Medications on Electrical Cardiac Conduction in the Emergency Department: A Best Practice Review , Juliann Hatt

Managing Pediatric Atopic Dermatitis in the Allergy Clinic: Use of an Eczema Action Plan to Improve Caregiver Understanding and Self-Efficacy, A Pilot Study , Danielle Hubacek

Achieving Advance Care Planning in Diverse Populations via Teleconferencing with Skilled Nursing Facility Residents , Tania Huezo

Utilizing Post Graduate Residency Program in New Graduate Nurse Practitioners to Improve Clinical Outcomes , LaShaunda Jethro

Establishment of Best Practice Skills for Advanced Practice Nurses , Leslie Kendrick; Tara Hughes; and Joseph Burkard DNSc, CRNA

Identifying Opportunities for Implementing Home Blood Pressure Monitoring in Newly Diagnosed or Worsening Hypertension at a Family Health Clinic , Catherine Liikala

Balancing Provider Stress and Resilience in the Time of COVID , Zachary Love

Health Disparities Associated with Pre-existing Cardiovascular Disease and Telemedicine Interventions during COVID-19 Pandemic: Best Practice Review with Recommendations , Barbara Mae Madriaga

Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Pregnant Women Living with HIV , Whitney Markowitz

Identifying Gaps in Follow-up Care Among Adults in an Occupational Health Setting: A Retrospective EBP Pilot , Ginny Meyerhuber, MSN, RN

Implementation of the Center for Disease Control (CDC) Prediabetes Risk Test in the Medical Weight Loss Setting , Gabriela Miller, RN, BSN

Sun Protection Behaviors in Patients with Actinic Keratosis , Madison Molotky

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PhD Thesis Prize

The Division of Nuclear Physics (DNP) encourages entries for the DNP Ph.D. thesis prize to be awarded in Experimental or Theoretical Nuclear Physics to any student receiving a Ph.D. degree from a Canadian University in the two calendar years prior to the competition deadline, i.e. 2019 and 2020 for the Jan 2021 deadline.

To be considered for the award, the completed checklist (pdf file attached below) and letter of nomination must be submitted by the thesis supervisor, along with an electronic (pdf) copy of the thesis to the DNP Chief Judge by the advertised date , which will be communicated by CAP. The nomination letter should describe in detail the contributions of the student to the research work. The student’s C.V., including a list of publications and conference contributions, should accompany the nomination. A letter from the Department Head or University Dean indicating that the thesis has been formally accepted by the University must also be submitted. Simultaneous submissions to the DTP, DNP, and PPD competitions are not allowed.

The prize winner will be asked to give an invited talk at the annual CAP Congress in June along with a seminar at TRIUMF. Travel expenses will be covered by the DNP and TRIUMF. The winner will also be required to submit a 1-2 page article suitable for publication in Physics in Canada describing the significance of the thesis work before they receive a cash award ($1000) from the DNP.

Both the supervisor and the nominee must be members of CAP and DNP (applications to CAP and DNP at the time of application are eligible; documentation must be provided and acceptance of the nomination is pending admission to CAP and DNP).

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• 2008-09 Competition
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Chapter 5:  Results and Discussion

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This chapter describes how to rewrite your Results and Discussion sections. Rewriting the Results section is straightforward—you present the results of your data analysis without embellishment just as you did in your dissertation or project report. The Discussion is more of a challenge because there's a lot more information to cover. You need to tell the readers what it all means, what to do with findings, how to build on them, and, in the case of a quality improvement project, how to sustain successful practice change. And do it all in a few pages.

In your Results section, you report your findings clearly and objectively, beginning with the primary outcome or most important results. Do not comment on, editorialize, or interpret what you found. If you conducted a quantitative study, rewriting your Results section is straightforward. With a qualitative study, you're working with many pages of transcribed interviews or field observations, which makes the task more difficult.

In your dissertation or scholarly practice project, you likely included every statistical test you conducted for a quantitative study. In rewriting your manuscript, only report results of analyses that answer the research question or address the hypotheses. However, make sure you report on all applicable tests; do not choose what results to include based on whether they support your desired outcomes.

In a practice project, the challenge is organization, particularly if you collected data and changed the implementation as you went along. One solution is to have both an Implementation and a Results section. In the Implementation section, you describe the implementation process as it proceeded. (See Chapter 4 , “Methods and Analysis.”) Include preliminary results and resultant changes for each small test of change if you used a Plan-Do-Study-Act process. Then report the final outcomes related to your purpose and specific objectives in the Results section.

Before rewriting the Results section, check the appropriate formatting guide, such as APA or AMA, and the journal's author guidelines for how to present your statistical results and how to format tables and figures. Also, look at the Results sections in articles in the journal for the following:

What is italicized?

How did the author refer to a table or figure in the text?

How did the author highlight significant results in a table (that is, use of asterisks)?

How did the author use commas, equal signs, spaces between symbols, and so on?

For both quantitative and qualitative research, and projects where appropriate, start with information about your final sample, including the number of participants, the response rate, and relevant demographics. If you excluded any participants from the analysis, state how many and why they were excluded. For example:

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PPD Thesis Award