The DNP project demonstrates student synthesis of evidence-based practice and research concepts taught across the program while laying the foundation for future scholarship. The DNP students select a project topic determined collaboratively with practice partners, stakeholders and faculty members. The topic forms the foundation for the DNP project with the goal of improving outcomes for individuals, groups, populations, communities and/or systems within Military and Federal Healthcare Systems.
Fort Bragg, NC
Project 1: VA/DoD mTBI CPG recommendations compared to actual practice
Impact: Overall, mTBI management aligned with the VA/DoD mTBI CPG, but areas for improvement were identified. Provider knowledge varied widely across the system; no formal mTBI training prior to high risk events; at risk soldiers not consistently identified; follow-up for soldiers with mTBI inconsistent
Project 2: Evaluating spouse mTBI education programs.
Impact: Spouse education is aligned with evidence based recommendations.
Project: Provider use of algorithms/recommendations in EXORG 165-13 Guidance for Management of Concussion/mTBI in Garrison
Impact: Effectiveness of EXORG 165-13. Findings can be used as a template for other MTF’s interested in improving mTBI management.
Joint Base Lewis-McCord, WA
Project 1: Identify current sexual assault screening practices in outpatient primary care.
Impact: 25% of patients are routinely screened for sexual assault. Patients and providers agree that regular sexual assault screening should be conducted using a standardized set of screening questions.
Project 2: Develop, implement, and evaluate the effectiveness of an LGBT educational program for military healthcare providers.
Impact: Provider knowledge of many aspects of providing appropriate care for the LGBT community increased, which may improve healthcare delivery and outcomes for this vulnerable and often underserved population.
Project 1: Health care provider documentation of patient disclosure of a previously unreported sexual assault SA.
Impact Limited training on how a SA diagnosis should be coded in the Electronic Health Record EHR. Clinical practice guidelines and standardized sexual assault documentation training are needed.
Project 2: Primary care for sexual assault victims from initial assault through follow-up.
Impact Using a Clinical Flow Sheet Post-Sexual Assault tool could improve access to comprehensive care for victims in acute, primary care and behavioral health settings. Particularly important for time sensitive interventions like sexually transmitted infection testing and physical exams.
Ft. Hood, Texas
Project: Program evaluation of PCMH implementation in one clinic to determine alignment with the NCQA PCMH 2011 Standards 1 and 3 Access/Continuity and Plan/Manage Care.
Impact: Variances identified in 47% of 58 factors assessed. Evidence-based recommendations for all variances communicated in a formal report and numerous presentations.
Project: Secure messaging (SMS) and list registry tool policy, evidence and use in a Patient Centered Medical Home.
Impact: Some of the most promising capabilities of secure messaging and list registry tools SMSMS & CP4G are not being used at the health system/patient interface. These tools could increase access to primary care.
Project: Evaluate evidence for and local implementation of the Army Weight Control Regulation (AR 600-9).
Impact: Although AR 600-9 achieves its intended objectives, several recommendations: identify more accurate tools for measuring body fat, improve provider education related to assisting soldiers with weight loss goals and add behavioral health interventions to the regulation.
Project: Resources and alignment of “Exercise is Medicine” EIM processes with the American College of Sports Medicine EIM exercise participation.
Impact: Inconsistent application of EIM at Ft Hood. Integrated multiple exercise resources and integrated an evidence-based exercise model to increase participation in exercise.
Project: Develop, implement, and evaluate the effectiveness of an LGBT educational program for military healthcare providers.
Impact: The program increased provider knowledge of many aspects of providing appropriate care for the LGBT community, and may improve healthcare delivery and outcomes for this vulnerable and often underserved population.
Joint Base San Antonio, TX
Project: Describe military sexual assault MSA policies, examine screening and assess follow-up care
Impact: No mandate in DoD or USAF policy for pre-accession SA screening, despite strong association between prior victimization and adverse outcomes in individuals with a SA history. Recommendations: provide MSA provider training to improve SA follow-up care; create policies addressing provider training, case management and patient education.
Ft. Belvoir, VA
Project: Determine safest, most effective anesthetic approach for patients undergoing ERCP and pilot a practice change
Impact: Evidence-based ERCP decision-support algorithm created, anesthesia providers educated and follow-up survey demonstrated that >50% of providers changed their practice.
Naval Medical Center Portsmouth, VA
Project: Usefulness of manometry-guided endotracheal tube ET cuff inflation
Impact: Manometry most effective way to assess and maintain ideal ET Cuff inflation pressure between 20-30 mmhg.
Naval Hospital Jacksonville, FL
Project: Create standardized preoperative diabetes medication instructions
Impact: Preoperative diabetes medication instruction tool standardized preoperative diabetes medication instruction and improved provider knowledge and confidence scores
Naval Station San Diego, CA
Project: Improve knowledge and confidence among nurses caring for patients at risk for respiratory depression
Impact: CRM curriculum developed and deployed via Learning Management System, post education evaluation overwhelmingly positive
Project: Determine feasibility/usability of a Test-Specific Checklist and Global Rating Scale GRS in evaluating CRNA Ultrasound Guided Regional Anesthesia competency.
Impact: Checklist/GRS combination is feasible and useful in a clinical setting and tool could easily be integrated into MTF staffing/ credentialing policies.
Wright-Patterson AFB, OH
Project: Examine why Ketamine a highly effective non-opioid analgesic, is not widely used in anesthesia practice.
Impact: Developed curriculum, trained providers, explored pharmacy formulations and drafted policy to increase perioperative use of Ketamine.
Eglin AFB, FL
Project: Gap analysis of neurosurgical and anesthesia policies for 1- and 2-level lumbar fusions.
Impact: Aligned policy with practice, improving consistency of care and conserving health care resources.