DNP Clinical Projects

One in six children in the United States (US) has one or more developmental delays (DDs). Developmental Delays occur when a child doesn’t meet a developmental milestone compared to expected development. Less than ¼ of children with DDs access intervention services, such as Early Intervention (EI), which offset complications. The aim of this Doctor of Nursing Practice (DNP) project was to improve early detection of developmental delays and increase referral rates to intervention services for children aged two through 60 months by consistent use of an evidence-based developmental screening tool, Ages and Stages 3^rd Edition Questionnaire (ASQ-3).

Methods: Brief training presentations of the validated developmental screener, the ASQ-3, were administered at two meetings, approximately six weeks apart during a 15-week timeline to family nurse practitioner (FNP) participants at the project site. Patient data were collected three months prior to the implementation of the project via chart audits and compared with three months of data obtained from the children seen by the FNPs after the intervention was initiated. Anonymous FNP surveys were delivered; one pre-test and two post-test surveys, which assessed FNP knowledge and confidence.

Results: An increase in the identification of DDs and of referral rates improved from 7.2% (pre-intervention) to 13.2% (post-intervention) and 7.2% to 13.2 % respectively. ASQ-3 completions improved from 40% in the pre-intervention group to 57% in the post-intervention group. Based on the second post-test survey, FNPs reported a 54% increase in being very knowledgeable regarding the use of the ASQ-3.

Conclusions: The consistent utilization of the ASQ-3 developmental screener increased the detection of DDs and referral rates in pediatric patients. Brief ASQ-3 presentations and trainings enhanced the knowledge of FNP participants.

Dissemination: Presented to the University of Rochester Department of Family Medicine/Highland Family Medicine QI committee and also at the Department Community Meeting. A poster was also presented at the annual American Association of Nurse Practitioners (AANP) conference in September 2024.

The aorta is the largest vessel in the human body, which can be enlarged and at risk of rupture without any symptoms. If ruptured, this can cause death up to 81% of the time. Screening protocols can help identify these enlargements, or aneurysms, thus mitigating morbidity and mortality. The purpose of the study was to determine whether utilizing point of care ultrasound (POCUS) in the primary care setting would increase adherence to abdominal aortic aneurysm screening guidelines, decrease cost, and increase successful screening in the primary care setting. A quantitative descriptive research design was utilized to evaluate the implementation of a POCUS screening protocol by providing in-office scans with a handheld ultrasound device. This study revealed a higher-than-average AAA prevalence. Results of the study showed that bringing Point of Care AAA screening to the primary care clinic offers significantly increased adherence to screening and was preferred to traditional ultrasound.

Dissemination:
Geer, B. (2025). Point-of-care ultrasound for abdominal aortic aneurysm screening in the primary care setting. The Nurse Practitioner 50(4):p 33-39, April 2025. |
DOI: 10.1097/01.NPR.0000000000000299

Approximately 8.7 million Americans live with undiagnosed diabetes, with one in five of them being unaware they have Type 2 diabetes, and an additional 97.6 million American adults have prediabetes, with disproportionate impacts on minority communities. Examining medical records revealed a need for standardized screening protocols to identify diabetes risk, enabling early intervention in an urban primary care clinic and preventing delays in follow-up care. A nurse-led Quality Improvement (QI) initiative was developed, which integrated the American Diabetes Association/Centers for Disease Control and Prevention Prediabetes Risk Test (ADA/CDC PRT) into a standardized screening protocol. In addition, comprehensive education on diabetes risk factors and prevention strategies was provided. The ADA/CDC PRT correctly identified 74% (n =31) with hemoglobin A1c (HbA1c) levels indicating prediabetes or diabetes. Pearson correlation analysis revealed positive associations between the ADA/CDC PRT score and HbA1c levels (r = 0.359, p < 0.05), age (r = 0.623, p < 0.05), and BMI (r = 0.389, p < 0.05). Performance was also improved in patient diabetes prevention education, nutritionist referrals, HbA1c screening, and subsequent provider follow-up. The finding highlights the critical roles played by stakeholder engagement, continuous education, and the utilization of standardized protocols for screening in enhancing patient outcomes. The project’s insights highlight the importance of adopting standardized screening protocols in primary care settings to ensure early detection and timely intervention for individuals at risk of type 2 diabetes.

Dissemination: Dr. Li completed a poster presentation at the American Diabetes Association 2024 Scientific Sessions. She was also recognized by Queens Hospital and the NYC Health and Hospitals Organization with the Daisy Award. The award honors nurses who go above and beyond to not only provide patients and families with excellence in clinical care, but also compassion.