Digital Commons Network^™

Integrating A Functional Assessment Tool For Chronic Pain In Primary Care, Amanda Blanche Parent

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Chronic pain is prevalent in the United States. Frequently, rural primary care providers must manage patients’ chronic pain and any associated long-term opioids. Best evidence-based practices recommend, and in some cases state guidelines require, periodic functional assessment, for which the CDC endorses the PEG assessment scale.

Purpose: To integrate the PEG assessment scale into a rural, primary care practice and evaluate sustainability in following best evidence-based practice guidelines.

Methods: A one-year retrospective chart review determined the baseline quality and frequency of functional assessment. A pre-implementation survey was distributed to providers to assess knowledge of opioid prescribing guidelines and their …

Using Clinical Workflow Assessment Frameworks For Process Improvement Of Patient-Provider Communication In A Primary Care Office, Madeline Morris

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

The purpose of this project was to assess the current workflow for addressing the needs of patients between face-to-face healthcare visits at a primary care clinic in Northern New England. The assessment served as a framework to inform recommendations for process improvement interventions. Workflow was mapped using Lean’s value stream map (VSM) tool. Observational data and retrospective chart review were performed to collect information on time to complete tasks, equipment used, and personnel involved in each patient request. Key patterns in workflow variation, guided by theoretical frameworks of system constraints, were identified. Finally, a team brainstorming session was organized with …

Improving Communication Between Community Care Settings And Primary Care, Kristin Morgan

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

In older patients with more complex and chronic health concerns, consistency and continuity of care is essential. Patients often live in assisted living residences or independently with support from programs such as Support and Services at Home (SASH), so nurses are available to address concerns and assist with certain aspects of care. Effective inter-professional communication is essential, but communication of assessments and coordinating care with participants’ primary care providers is complex.

Purpose

Improve efficiency and clarity of care-related communication for patient and care team by developing a system that standardizes and streamlines workflow and addresses current concerns.

Methods

At …

Examining The Feasibility Of Integrating An Alcohol Detoxification Protocol Within Primary Care, Emily A. Miller, Dnpc, Bsn, Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Medically supervised, in-home alcohol detoxification is safe, efficacious, cost-effective, and satisfying for patients. However, it remains underutilized within primary care practices. This feasibility study aimed to examine clinician perceptions of adopting a standardized outpatient alcohol detoxification protocol at a rural primary care clinic where no internal protocol exists.

Methods: An ambulatory alcohol detoxification protocol was created using the American Society of Addiction Medicine guideline on alcohol withdrawal management and presented to 38 providers and 11 nurses. Twelve participants (six providers and six nurses) completed a modified version of the Implementation Process Assessment Tool. The instrument measured stakeholder perceptions of …

Implementing The Tcare Protocol In A Memory Program, Meaghan E. Knakal

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: This project created a protocol for use of the Tailored Caregiver Assessment and Referral Evaluation (TCARE)® screening tool in a Memory Program for assessing for caregiver stress in informal caregivers.

Methods: The TCARE® screening tool was researched, and then a protocol for use by nurse practitioners was created. Approval from the academic and hospital organization was received and the TCARE ®protocol for use was implemented in a Memory Program. Two PDSA cycles were utilized to evaluate this intervention. Findings were analyzed for sustainability and contribution to the clinical setting.

Results: All caregivers (n = 5) who completed the TCARE® …

Community Transitions Of Care For Hospital Readmission Prevention, Lauren Fedorka

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Transitions of Care (TOC) occur whenever an individual moves from one healthcare setting to another. Older adults are higher utilizers of healthcare services, including inpatient and emergent visits, than the general population (Tian, 2016), and thus experience more TOCs. Due to risk of poor outcomes at discharge from the hospital, rehospitalizations are a concern. Standardized TOC protocols have been shown to be beneficial in reducing rehospitalizations for this vulnerable population.

Purpose: Use current best practices to design and implement TOC for a rural community organization to reduce unintended rehospitalizations for older adults.

Methods: Best practices in TOC were …

Increasing Provider Use Of The Family Media Plan For Patients Ages 2-5, Christine Head

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

Currently in the United States, 56.1% of preschoolers use over one hour a day screen time, exceeding time recommendations set by the American Academy of Pediatrics (AAP) (Healthy People 2030, 2020). Excess screen use by preschoolers is detrimental to development, behavior, and increases the risk for obesity. The Family Media Plan (FMP) is an evidenced-based intervention developed by the AAP to reduce screen time use in pediatrics (Reid Chassiakos et al., 2016).

Purpose

To address preschoolers at risk for the overuse of screen time, this quality improvement project aimed to increase evidenced-based intervention for those ages 2-5 years old …

Implementing Social Determinants Of Health Screening Post Emergency Department Discharge, Grace Kenley

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Frequent emergency department use is defined as four or more visits a year. Individuals who frequent the emergency department often have social and health inequities, chronic illness, and live in rural settings. Healthcare complaints associated with frequent emergency department use can typically be managed in a primary care setting. Decreased emergency department use is a suspected outcome of addressing unmet social needs.

Purpose: Outcome measures include: 1) number of individuals seen in the emergency department on a weekly basis; 2) how individuals were called by the site RN and then subsequently screened for unmet social needs; 3) identified unmet …

Improving Access To Gender-Affirming Care: A Welcome Packet, Kelsey J. Rumley

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

BACKGROUND: Transgender and gender diverse (TGD) individuals face unique challenges in accessing healthcare such as stigma, bias, fear of rejection, limited access to providers, and lack of information on where to seek care. There is evidence that creating an inclusive clinic atmosphere improves access and leads to a more positive healthcare experience

AIMS: The global aim of this project is to improve access to gender-affirming care for students at a New England university. Specific aims were to assess stakeholder needs for content inclusion and develop a new patient welcome packet based on the needs assessment.

METHODS: The Plan Do Study …