Digital Commons Network^™

A Toolkit To Adequately Screen Pregnant Women For Depression And Thus Increase Screening In An Outpatient Obstetrical Clinic, Katherine Doherty

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal depression is a common health complication during pregnancy. Untreated depression among perinatal women is associated with adverse health outcomes for infants and mothers. Screening during the perinatal time period is needed to identify and treat depression and to prevent adverse health outcomes.

Purpose: The purpose of this clinical project is to equip health care providers with the knowledge and tools needed to screen pregnant women for depression and thus increase the amount of screening done in an outpatient obstetrical clinic.

Methods: An evidenced- based educational tool kit was developed to increase provider knowledge of perinatal depression …

Implementing Intimate Partner Violence Screening In The Primary Care Setting, Deirdre F. Howard

Doctor of Nursing Practice (DNP) Projects

Background. Intimate partner violence is a highly prevalent problem in the United States and leads to serious negative physical and psychological health outcomes, including death. There are screening tools that can detect IPV, yet screening rates in healthcare settings remain low, due to a variety of barriers, including lack of time, confidence, screening policies, and resources. Purpose. The purpose of this DNP project was to increase IPV screening rates within a primary care clinic.Methods. To accomplish the purpose of the project, an education intervention on IPV and available resources was provided to clinicians and staff. This was followed by …

Implementation Of An Evidence-Based Screening Tool For Children For Detection Of Developmental, Behavioral And Family Issues, Lyndsay Goss

Doctor of Nursing Practice (DNP) Projects

Background: Children are a vulnerable population who are at risk for a variety of developmental, behavioral and family concerns. Early intervention leads to improved outcomes. By implementing the comprehensive evidence-based screening tool the Survey of Well-being for Young Children (SWYC), within a Federally Qualified Health Center (FQHC), outcomes for these children may be improved through early intervention.

Methods: The SWYC survey was provided to parents and guardians of children ages zero to five years at one pilot site at a FQHC in New England during well child visits (WCV) over a 6-week period. Implementation success was measured through review …

Evaluating The Impact Of An Educational Program On The Healthcare Providers Knowledge On Depression And Screening Among Adolescents And Young Adults, Albert Peprah

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Alcohol Screening In A Pain Clinic To Reduce The Risk Of Overdose And Improve Patient Care And Compliance With Prescription Opioids, Alicia Ellis

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The nationwide opioid crisis is having a significant impact on the U.S. population. Patients may turn to alcohol and opioids for pain relief, which can lead to cancer, alcoholic liver disease, and heart disease. Providers can improve outcomes by screening patients for alcohol use prior to getting an opioid prescription using the Audit-C screening tool.

Purpose: This DNP Project started formal screening for alcohol abuse in a small rural pain clinic with five hundred patients per month.

Methods: During the first visit, patients were triaged by the nurse and screened using the AUDIT-C tool and had a urine …

Improving Osteoporosis Screening Rates In A Primary Care Practice, Heidi Doreau

Doctor of Nursing Practice (DNP) Projects

Background: Osteoporosis is a prevalent condition that is often overlooked until a fragility fracture occurs. Screening for bone loss with dual-energy X-ray absorptiometry (DXA) scans is underutilized in the primary care setting. Direct communication with at-risk patients, offering self-referral for DXA screening, has been demonstrated to be the most effective intervention in increasing DXA screening rates.

Purpose: The goal of this DNP project was to improve bone density screening rates in a primary care practice by inviting patients at greatest risk of osteoporosis to schedule a DXA without a provider order.

Methods: After a review of the electronic medical record, …

Improving Intimate Partner Violence Screening Practices Among Postpartum Nurses, Robin Mills-Humphreys

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of the Literature: Intimate partner violence (IPV) during pregnancy is a global public health issue that has negative outcomes on both an individual and a societal level. Health care providers play a pivotal role in providing services to women experiencing violence during pregnancy. Regardless of the setting, barriers to IPV screening exist among healthcare providers. Review of the literature examined the existing IPV screening practices and screening barriers among healthcare providers to better understand the relationship between barriers and frequency of screening for IPV. Purpose: The purpose of this DNP project was to enhance …

Markov Decision Process Approach To Strategize National Breast Cancer Screening Policy In Data-Limited Settings, Vijeta Deshpande

Masters Theses

Early diagnosis is a promising strategy to reduce premature mortalities and for optimal use of resources. But the absence of mathematical models specific to the data settings in LMIC’s impedes the construction of economic analysis necessary for decision-makers in the development of cancer control programs. This thesis presents a new methodology for parameterizing the natural history model of breast cancer based on data availabilities in low and middle income countries, and formulation of a control optimization problem to find the optimal screening schedule for mammography screening, solved using dynamic programming. As harms and benefits are known to increase with the …

Quality Improvement: Intimate Partner Violence Screen In Nurse Home Visit Program, Masayo Nishiyama

Doctor of Nursing Practice (DNP) Projects

Purpose: Women are disproportionately impacted from intimate partner violence (IPV). Their children also experience long-term adverse consequences. Effective IPV prevention and intervention efforts are vital. This quality improvement project addressed the lack of an evidence-based IPV training and protocol in a nurse home visit program.

Methods: Stakeholder engagement and an evidence-based practice intervention were implemented. Training effectiveness was examined by the pre-post-training assessments; completed by 17 nurses. To measure the IPV practice change, 196 pre- and 107 post-intervention charts were reviewed.

Results: The training significantly increased nurse knowledge and comfort (t=5.9, p< .001). Only 22% of those referred due to recent IPV history were screened before the intervention; 65% after the intervention. Multivariate analysis of screening rates was performed; predictors included county, mental health status, education, subprogram, and IPV referral reason. Due to low power, a one-tail test was employed. One county was 14 times less likely to screen than the other county (p= .023). 93% of those referred due to IPV history were enrolled in the crisis response subprogram, only offered by the other county. Those referred due to IPV history were three times more likely to be screened (p=.042) than those referred for other reasons. There was no significant change observed on IPV disclosure and intervention practice.

Conclusions: The adoption of an evidence-based IPV training …

Promoting Sleep Health Through Identification And Management Of Obstructive Sleep Apnea, Melissa Vuolo

Doctor of Nursing Practice (DNP) Projects

Background: There is a high prevalence of obstructive sleep apnea in the United States, which left untreated can lead to increased cardiovascular risk. The current practice standard is to use a questionnaire to evaluate a patients’ sleep health, but this is not done regularly in every clinical setting. This DNP project aimed to bridge the gap in practice by implementing regular screening of obstructive sleep apnea in an urgent care center in Massachusetts.

Methods: This DNP project was conducted by having adult patients complete the Epworth Sleepiness Scale to determine the presence of a sleep health issue. The patients …

Increasing Staff Knowledge And Screening Practices For Adverse Childhood Experiences In Primary Care, Angela Mcgraw

Doctor of Nursing Practice (DNP) Projects

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened …

Screening For Trauma In The Foster Care Community, Catrina Graham

Doctor of Nursing Practice (DNP) Projects

Children within the foster care community experience health disparities on a variety of levels, from physical and mental health conditions, developmental delay, and impaired social interactions. Many of these conditions can stem from the experience of trauma or adverse childhood events that color each component of their lives. For healthcare providers to be successful in the assessment and treatment of this community, an understanding of traumatic events and the delivery of trauma-informed care is essential. The complex needs of this community are such that the provision of healthcare must be specialized, multidimensional, and organized. The purpose of this project is …

Screening For Traumatic Brain Injuries (Tbi) In Veterans: A Quality Improvement Project To Change The Identification And Referral Process In Primary Care Providers., Chiara Simonini

Doctor of Nursing Practice (DNP) Projects

Background: The incidence of traumatic brain injuries (TBI) among veterans has increased exponentially in those who served in Operation Enduring Freedom and Operation Iraqi Freedom. Identification and treatment for these injuries remains difficult due to variance in screening methods, interpretation of results, and barriers to access to care. Purpose: The goal of this quality improvement project is to improve TBI screening process offered to veterans by healthcare workers and providers in an outpatient VA clinic in the northeast. Methods: Current standards of practice and provider knowledge were assessed through focus groups, pre-intervention survey, followed by educational outreach to provide …

A Quality Improvement Project To Improve Type 2 Diabetes Mellitus Screening In Asian Americans Using Body Mass Index Cut Point Of 23, Annie Samuel

Doctor of Nursing Practice (DNP) Projects

Background: Asian Americans are at a higher risk for Type II Diabetes than other groups and disproportionately develop Type II Diabetes Mellitus at younger ages, although having a lower Body Mass Index (BMI) compared to non-Hispanic whites.

Methods: A group of 22 Nurse Practitioners (NP) in New York were presented an evidence-based educational intervention along with a five-item pre-test and post-test to determine if they had acquired new knowledge on the issue. A follow-up survey was conducted to test if the intervention changed individual NP practice in screening Asian Americans in adult primary care clinics.

Results: The overall mean …

Managing Patients At High-Risk For Breast Cancer: An Elearning Module For Primary Care Providers, Erin Chaney

Doctor of Nursing Practice (DNP) Projects

Women at high-risk of developing breast cancer must be screened appropriately and educated about breast cancer reduction strategies much earlier than those of average risk. The National Comprehensive Cancer Network (NCCN) (2017) has identified guidelines for the care of this group. This project focused on the development of education for providers, specifically an eLearning module, to help translate guidelines into practice. Providers of adult primary care (including internal medicine and family practice) from four clinics in Snohomish County, Washington, were asked to participate in an eLearning module regarding the care of patients at high-risk for breast cancer. Repeated measures surveys …

Intimate Partner Violence Screening, Elsa Dehart

Doctor of Nursing Practice (DNP) Projects

Background: Intimate partner violence (IPV) has become pervasive in our society and is a major public health threat. More than one in three women (35.6%) and one in four men (28.5%) in the United States have experienced violence at the hands of an intimate partner at a cost of 12.6 billion annually. Intimate partner violence includes physical, sexual or psychological assault, including physical aggression, sexual coercion, psychological abuse and controlling behaviors by one who is, was or wants to be in an intimate relationship. Health care provider contacts are an appropriate place for an intervention aimed at reducing the rates …

An Evaluation Of The Feasibility Of Implementing The National Institute Of Children’S Health Quality (Nichq) Physical Activity And Nutrition Survey In Pediatric Primary Care, Candice Greene

Doctor of Nursing Practice (DNP) Projects

Pediatric obesity is a growing problem in the United States of America causing both immediate and long-term health implications including: cardiovascular disease, diabetes, bone and joint problems, sleep apnea, and social and psychological problems (Centers for Disease Control and Prevention, 2015). The purpose of this quality improvement project is to implement and evaluate an evidence-based screening tool for identifying modifiable risk factors for childhood obesity in children in a pediatric primary care office. The National Institute for Children’s Health Quality (NICHQ) Physical Activity and Nutrition Survey (Appendix A) was administered to 25 pediatric patients ages 2-18 presenting to their primary …

Implementation Barriers Of The Phq-9 In Primary Care: A Quality Improvement Project, Angela P. Miller

Doctor of Nursing Practice (DNP) Projects

Purpose: The purpose of this research translation project was to mitigate the consequences of under-recognition, and under-treatment of depression through use of an evidence-based depression-screening tool, the PHQ-9, in a primary care setting.

Methods: A plan-do-study-act model was utilized for the implementation of this initiative. An informal educational intervention about administration and interpretation of the PHQ-9 first took place at the provider level in a primary care practice. Next, a pre and post-test study design (n=12) was administered to providers, nursing, and ancillary staff. A report was shared at monthly quality meetings with representatives from each practice in the health …

An Evaluation Of An Educational Program For Improving The Accuracy Of Ecg Interpretation In Athletes By Primary Care Clinicians, Stephen F. Segatore Jr

Doctor of Nursing Practice (DNP) Projects

Background: In order to identify athletes at risk for sudden cardiac death (SCD), comprehensive screening that includes ECG interpretation is needed. Many primary care providers, including physicians and nurse practitioners, have reservations about including electrocardiograms (ECG) in the screening process because they lack confidence in their ability to correctly identify normal variants in the ECG of an athlete.

Method: An educational program with previously validated interpretation criteria for normal variants of the athletic heart was presented to providers at a university based healthcare clinic the Northeast. A pre and post design was used to compare the accuracy of ECG …

Screening For Sleep Apnea In The Heart Failure Population, Loreen M. Williams

Doctor of Nursing Practice (DNP) Projects

Background: Sleep disordered breathing (SDB) occurs in over half of the estimated 5.1 million people in the U.S. diagnosed with heart failure (HF). Evidence shows that treatment of SDB in this population decreases not only morbidity and mortality rates, but the overall cost burden of the disease as well. The routine use of a sleep apnea screening protocol in the HF population can help identify patients in need of treatment. Methods: A project was conducted at an urban community heart failure clinic to evaluate provider preference of three evidence-based screening tools to be included in the implementation of a comprehensive …