
At the UF College of Nursing, DNP students must think big and take on weighty issues when designing their graduate projects.
“When you become a DNP, it is about the big picture. About your population. About your organization. About your system. How do you improve care for the larger group rather than one patient at a time,” said Associate Dean For Academic Affairs – Graduate Clinical Education Rene Love, PhD, DNP, PMHNP-BC, FNAP, FAANP, FAAN.
With that in mind, students identify organizational gaps and try to make a difference.
“We want DNP students to understand how to improve care for patients. So, when they do projects, the mantra is, you want care to be better for patients when you leave than before you walked in,” Love said.
This year, some projects exceeded expectations, including one that received a $20,000 W. Martin Smith Interdisciplinary Patient Safety Award and another set to publish in the Journal of Emergency Nursing.
Courtney Rodriguez-Cayro, a recent College of Nursing DNP graduate, believed lax patient oral hygiene standards were responsible for increased pneumonia cases. A study she helped design to standardize formal oral care protocols in one unit at UF Health Shands saw cases drop and caught the attention of clinical leaders. That attention led to the $20,000 UF award, allowing her to continue the study.
Katelyn Watts, another recent DNP graduate, worked with Baptist Health in Jacksonville on ways to screen for human trafficking victims seeking medical attention in the emergency room. A screening tool was designed and rolled out into the EPIC system, one of the largest electronic health records companies. During the three-month project period, the screening tool helped identify five human trafficking victims and netted three arrests.
“Not every project is like that. But they are all pretty amazing. What they are doing is impactful. They are embedding evidence-based practices into the clinical setting,” Love said. “It is usually a rigorous process to make sustainable organizational changes. We all know these are wonderful things, but implementing it takes time, energy, and effort.”
Maximizing Education
This year, two projects focused on programs at the Urban Health Alliance’s Food Pharmacy and Social Services Hub in Jacksonville.
The food pharmacy, established in 2021 and based out of UF Health Jacksonville’s Total Care Clinic, focuses on improving the health and well-being of the community’s most vulnerable patients by addressing aspects of the social determinants of health.
Jessica Kirkey and Ashley Marie-Mendez evaluated the online educational material for hypertension and diabetes, respectively.
Patients with hypertension and diabetes are referred to the food pharmacy if their primary care provider identifies them as having food insecurity. The food pharmacy, via dieticians, teaches patients what and what not to eat to help manage their chronic conditions. They supplement clients with healthy food for several months. The program also offers cooking classes and online education. Previous DNP students developed the educational component.
Kirkey surveyed program stakeholders and previous DNP students who worked with the food pharmacy, seeking their thoughts on barriers to participation. She also surveyed food pharmacy clients, asking for ways of improving the program.
The surveys revealed that less than 32% of clients participated in online education. Still, almost 94% of clients reported they made lifestyle changes.
The greatest obstacle to online participation was the need for more available videos and access to technology. Clients reported they preferred print information. Stakeholders and students reported clients had difficulty navigating YouTube and did not know how to use QR codes. Clients preferred face-to-face education, possibly paired with cooking classes.
“I think it would be an opportunity for future DNP projects or BSN students to do weekly in-person education,” Kirkey said, adding that using direct video links embedded in electronic charts could also improve access.
Mendez also found an education deficit among diabetic patients at the food pharmacy.
“The guidelines suggest self-management training as the best form of diabetic education, and only 6.8% of patients with a diabetes diagnosis are receiving that education,” Mendez said.
Mendez also used surveys of food pharmacy patients and stakeholders for feedback. As with the hypertension patients, 92% of diabetic patients reported making lifestyle changes since joining the food pharmacy. The diabetic patients also wanted more videos, but technology was similarly a barrier.
“We’ve had over 10 DNP student graduates who have done projects at the food pharmacy. So, it just shows the amount of work that’s gone into this, and these two have finally been able to evaluate that work,” said Associate Professor Jane Carrington, PhD, RN, FAAN, FAMIA, who mentors and teaches DNP students.
Improved Rapid Response
Constance Hartman noticed at her hospital that nurses did not always get the appropriate patient information during rapid response calls, delaying intervention. She wondered if there was a better way to have patient details quickly available.
A rapid response call is issued when a patient shows signs of imminent crisis. The call triggers a team of providers to converge at the bedside to assess and treat the patient and prevent a cardiac arrest and possible death. Team members at Hartman’s hospital included ICU nurses.
“My goal was to activate something that would help with the triage process,” Hartman said. “There was a lot of frustration with the rapid response team. They spent much of their time when they first got to the call trying to obtain the information.”
Hartman began by integrating the SBAR tool for rapid response calls on one of the hospital units. SBAR is an acronym for situation, background, assessment, and recommendation. It is a handoff tool that delivers the necessary information quickly and concisely and can improve patient safety.
Unit nurses were educated on performing a patient handoff to the rapid response team using SBAR. By the end of the project period, rapid response team members reported that SBAR was a good standard of communication to adopt.
Hartman would like to continue with the project and investigate how using SBAR affects patient outcomes.
Looking Ahead
Hartman is not alone. Love said it’s not unusual for students to continue developing their projects.
While Courtney Rodriguez-Cayro already has funding, she planned to move forward before the award.
“It’s great that I don’t have to worry about finding funding to continue,” she said, adding that the award will allow hiring a statistician to analyze the study results. She also hopes to publish the study.
Katelyn Watts also will continue her project and is scheduled to present it at several upcoming conferences. Combatting human trafficking has been close to her heart due to her past work as a pediatric nurse and seeing victims first-hand.
“Some of these projects take years to do. They may be working on them their whole careers,” Love said.