Digital Commons Network^™

Intervention For Increasing Advance Directive Documentation In The Primary Care Setting By Placing A Flag In The Electronic Medical Record (Emr), Linda Wilson

Doctor of Nursing Practice (DNP) Projects

Abstract

Regardless of the Patient Self-Determination Act in 1992, only 15% of Americans have an

advance directive (AD). This will be an even more significant factor by 2030 when the expected elderly population will be 72.1 million people. Purpose: If an individual does not have an AD, they may be subjected to futile, costly and unnecessary suffering at end-of-life. Loved ones may also suffer the emotional burden of not knowing what type of care is wanted if the person is unable to communicate. Primary care providers are first line in caring for patients and are in an ideal position …

Mindfulness-Based Stress Reduction (Mbsr) In Reducing Stress In Nursing Students: An Integrative Review And Toolkit, Donna J. Petko

Doctor of Nursing Practice (DNP) Projects

Background: Across the country, nursing students are experiencing alarming amounts of stress. While stress is a common phenomenon, it has been shown to negatively impact nursing student performance and general health. One solution to this issue is mindfulness-based stress reduction (MBSR). Reported effects of MBSR include stress reduction; mindfulness; improvements in self-esteem; increase in general health; a decrease in anxiety; and an increase in empathy. Because MBSR is not widely included in nursing curricula, students are not learning stress reduction techniques needed to manage daily stress. Purpose: To address this gap, a DNP project was implemented at a university site. …

Improving Pertussis Education For Postpartum Women And Their Family Members, Marlene Unisa

Doctor of Nursing Practice (DNP) Projects

Abstract

Background:The purpose of this DNP project was to synthesize evidenced based-research related to Tdap vaccination against pertussis for family members of pregnant and postpartum women in order to provide protection from pertussis for newborn infants through cocooning. Cocooning refers to the vaccination of family members and caregivers in close contact with the infant to protect the infant by lowering risk of acquiring pertussis from close contact through an infected family member.

Methods: This project utilized the Health Belief Model to understand perceptions and predict behaviors related to the pertussis vaccination of family members who may come in contact …

Effectiveness Of Educating Parents Of Children With Attention Deficit Hyperactivity Disorder (Adhd) On Children’S Behavioral Issues And The Stress Experienced By Parents: An Integrative Review, Vivaksha Khanduri

Doctor of Nursing Practice (DNP) Projects

Background: Attention deficit hyperactivity disorder (ADHD) is a common condition characterized by hyperactivity, impulsivity, and inattention. Over 50% of children diagnosed with ADHD experience these symptoms into adulthood. The symptoms of ADHD a child exhibits can be very challenging for parents to manage and their understanding of the child’s behavior is often limited. Parenting programs include psychosocial interventions that teach techniques that parents can use to manage their child’s challenging behavior. Parent-focused education on managing symptoms for a child with ADHD has been shown to improve quality of life for both parents and child.

Objective: To determine whether parent training …

An Evaluation Of An Assisted Living Facility: Satisfaction, Access To Care, And Issues With Cost, Ryan Brogan

Doctor of Nursing Practice (DNP) Projects

Background. Many older adults and their families are faced with difficulties paying for safe living situations as well as the expenses of healthcare for those with chronic diseases. Assisted living facilities provide support to patients and their families in this, however costs can be high and services limited.

Methods: Residents and their families were given a questionnaire related to reasons for choosing an assisted living facility and the expectations of the facility and services as well as their satisfaction with living there and the care received.

Results: Twenty-one people filled out the questionnaire. The most frequently cited reasons for …

An Integrative Review With Toolkit For Caregivers Of Persons With Dementia, Lea Grippin

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The risk of burnout among caregivers of people with dementia is on the increase. Dementia is a progressive neuropsychiatric disorder affecting the cognitive function resulting in confusion and disorientation leading to greater demands on the caregiver which can lead to depression, social isolation, stress, worsening personal health, anxiety, fatigue, financial losses, and potential for abuse.

Methods: This project focused on creating a toolkit for nursing staff caring for patients with dementia followed by a presentation designed to provide options for caregiver support that can assist the caregiver in decreasing their feelings of stress and burnout. This included strategies …

Improving Mobility For Older Adults In The Acute Rehabilitation Setting, Joan E. Kucienski

Doctor of Nursing Practice (DNP) Projects

Purpose: This Doctorate of Nursing Practice (DNP) scholarly quality improvement project focused on implementing a Get Up and Go exercise program to increase mobility in an acute 80 bed rehabilitation facility. The goal of increased exercise was for patients to return to their pre-hospital level of function. Methods: This quality improvement projects’ purpose was aimed at increasing mobility to three times a day in patients over the age of 65. Caregivers were educated on the exercise Get Up and Go, along with the documentation of the increased mobility in the electronic medical record. The DNP Project took place over …

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 …

The Negative Impact Of Excessive Screen Time On Language Development In Children Under 6-Years-Old: An Integrative Review With Screen Time Reduction Toolkit And Presentation For Outpatient Pediatric And Family Health Providers, Cristina Kuta

Doctor of Nursing Practice (DNP) Projects

Background. Increased amounts of recreational screen time, defined as time watching television and DVDs, playing videogames, and using computers, tablets, and cellular phones without academic purpose, and the lack of effective media use assessment and patient education being done by primary care providers is associated with increased risk of language developmental delays for young children under 6-years-old.

Purpose. The purpose of this integrative review is to develop a toolkit that provides education for providers and families on the adverse effects of excessive screen time on language development in children younger than 6-years-old and evidence-based screen time reduction strategies that can …

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 …

Increasing Exercise For Patients With Diabetes Using A Mobile App – A Quality Improvement Project, Jill Jolin

Doctor of Nursing Practice (DNP) Projects

Background: A literature review on Type 2 Diabetes Mellitus (T2DM) indicates that a combination of aerobic and resistance exercise leads to overall beneficial physical and psychological health benefits for people that have a diagnosis of Diabetes. Behavior change and social support are identified as essential factors that facilitate and help maintain a productive and committed exercise program for people with Diabetes. Patient self-management is an important indicator in maintaining good control of diabetes, and mobile phone interventions have been shown to improve such self-management. Exercise is an important component of treatment, and prevention of T2DM although people struggle with incorporating …

Motivational Interviewing, And Healthy Eating Intervention With Low Income Diabetic Patients, Cornelius Bela

Doctor of Nursing Practice (DNP) Projects

Purpose: The project’s aim was to investigate whether motivational interviewing made a difference for the participants in terms of healthy behaviors, as measured by their weight, BMI, HgA1C and total health eating habits score.

Method: A motivational interviewing intervention was used on thirteen diabetic patients in three monthly group meetings and weekly phone calls surrounding healthy eating. The health behaviors such as improving dietary choices, decreasing sedentary behaviors, and increasing habitual physical activity and exercises were assessed at both pre and post intervention as well as weight, body mass index (BMI), Hemoglobin A1c, and healthy eating habits total score.

Results: …

Educational Intervention For Health Care Providers Prescribing Opioids For Individuals With Chronic Pain, Sonya Lachance

Doctor of Nursing Practice (DNP) Projects

Background: Health care providers (HCP) are the primary caregivers for chronic pain in ambulatory care practice and are the predominant prescribers of opioids. Pain medication accounts for at least 11% of all prescriptions in ambulatory care yet research suggests the number could be as high as 20%. Given the current opioid epidemic, HCPs need guidelines to assist in treating chronic pain patients.

Methods: An educational intervention was implemented in a primary care practice to increase provider knowledge of chronic pain management and opioid prescribing utilizing a pre-survey, PowerPoint presentation, and post-knowledge survey.

Results: Seven providers attended the education intervention and …

An Educational Toolkit To Promote Lung Cancer Screening In Primary Care, Courtney Cloonan

Doctor of Nursing Practice (DNP) Projects

Lung cancer is the leading cause of cancer mortality in the United States for both men and women. Lung cancer screening with low-dose computed tomography (LDCT) demonstrates reductions in lung cancer mortality and all-cause mortality, and improved rates of early stage diagnosis in high-risk current and former adult smokers. Evidence-based screening guidelines include annual LDCT in high-risk current and former adult smokers; however, these guidelines have not been fully translated into clinical practice. The purpose of this project was to create a toolkit for lung cancer screening to assist primary care providers in educating and screening their patients at high-risk …

Effect Of Provider Education On Pulmonary Rehabilitation Referrals And Discussions With Patients, Shannon Barry

Doctor of Nursing Practice (DNP) Projects

Background: Chronic obstructive pulmonary disease (COPD) is a chronic and debilitating disease from which 9% of the population suffers (CDC, 2013). Pulmonary rehabilitation (PR) is a well-documented evidence-based intervention for patients with chronic respiratory diseases, leading to better health outcomes for patients; however, PR is grossly underutilized in primary care (Rochester et al., 2015). Providers face many barriers which cause this gap between the evidence and clinical practice, such as a lack of understanding of the rehabilitation program and insurance coverage (Rochester et al., 2015).

Purpose: The aim of this Doctor of Nursing Practice (DNP) project was to launch a …

Cultural And Health Literacy Assessment Of The Hispanic/Latino Patient Population: Presentation Of A Cultural Competence Toolkit For Acute Care Nurses, Patricia Moore

Doctor of Nursing Practice (DNP) Projects

Background: Barriers to effective communication, such as low health literacy, language, and cultural differences, play a role in the health disparities that affect the Hispanic/Latino population. These barriers have generally been considered in isolation; interventions designed to overcome low health literacy have typically been separate from those focused on decreasing cultural and linguistic barriers. Nurses must understand that culture and language establish the framework for the attainment of health literacy skills, and strive to work within the cultural context of the patient. Methods: Best practices for cultural and health literacy assessment and culturally appropriate nursing interventions were used to develop …

Intervention For Increasing Advance Directive Documentation In The Primary Care Setting By Placing A Flag In The Electronic Medical Record (Emr), Linda Wilson

Doctor of Nursing Practice (DNP) Projects

Abstract

Regardless of the Patient Self-Determination Act in 1992, only 15% of Americans have an

advance directive (AD). This will be an even more significant factor by 2030 when the expected elderly population will be 72.1 million people. Purpose: If an individual does not have an AD, they may be subjected to futile, costly and unnecessary suffering at end-of-life. Loved ones may also suffer the emotional burden of not knowing what type of care is wanted if the person is unable to communicate. Primary care providers are first line in caring for patients and are in an ideal position …

Delivering Culturally Competent Care To The Lesbian, Gay, Bisexual, And Transgender (Lgbt) Population, Evan M. Mcewing

Doctor of Nursing Practice (DNP) Projects

Purpose: To this day, the lesbian, gay, bisexual, and transgender (LGBT) communities still experience negative health outcomes due to social stigma and discrimination. Additionally, nursing has lagged behind other health professions in the promotion of culturally competent care to members of this minority group. Several national authorities on LGBT health have proposed guidelines for providing such care to the LGBT population; however, many nursing schools are not integrating these recommendations into their curricula. Methods: Using these national guidelines, an educational program was developed for BSN students at a large south Florida university to improve competency in providing care for LGBT …

A Friendly Adolescent Care Environment For Utilization Of A Pregnancy Prevention Program (Face-Up): Providing Pregnancy Prevention Strategies For At-Risk Youth, Ashley Turner

Doctor of Nursing Practice (DNP) Projects

Problem: Teen pregnancy often results in a variety of economic and social costs for the adolescents and their children. Despite recent declines, teen pregnancy rates continue to be the highest in the United States versus other industrialized nations. Purpose: Evaluate the efficacy of an educational intervention DNP project, called the Friendly Adolescent Care Environment for Utilization of a Pregnancy Prevention Model (FACE-UP), in providing pregnancy prevention strategies to at-risk high school students in Washington, D.C. The goal of this educational intervention was to decrease risk behavior patterns and increase knowledge to empower student participants. Method: The Realityworks’ Healthy Choices Curriculum …

Refugee Health Education: “Learn To Succeed. Together We Build Our Community.”, Maria Theresa P. Panizales

Doctor of Nursing Practice (DNP) Projects

Background: The United States Refugee Resettlement Program (RRP) advocates and supports resettled refugees towards self-sufficiency within 8 months of arriving in the US. The program assumes that refugees are able to attain autonomy within a limited time frame notwithstanding a lack of English language proficiency, low literacy, and socio-cultural discordance. After the RRP support, resettled refugees continue to experience disparities in health knowledge and a gap in socio-cultural awareness, which contribute to poor health outcomes. Purpose: To develop, implement, and evaluate the impact of a comprehensive culturally sensitive health education program in addressing resettled refugees’ identified health needs resulting from …

Integrative Review For Identifying Patients Appropriate For End-Of-Life Care Interventions By, Melissa Ellis

Doctor of Nursing Practice (DNP) Projects

Background: End of life is defined as the last 12 months before a person dies, with 1% of the total population passing each year. Primary care providers can predict end of life and implement interventions. Early identification of patients for palliative care prevents crises, meets the needs of patients and families, and reduces the cost of healthcare. Screening for end-of-life care needs in primary care using the Gold Standards Framework (GSF) and the Prognostic Indicator Guidance (PIG) tool/surprise question will minimize risk of missed interventional opportunities.

Purpose: This educational intervention served to increase provider knowledge of the GSF …

Advanced Directives In Primary Care, Kathryn Sondrini

Doctor of Nursing Practice (DNP) Projects

The disclosure of information to patients on the subject of code status is variable as there is a lack of evidence based practice or standardized disclosure of information. Multiple articles and studies have been reviewed which illustrate such a deficit but do not indicate how to either create or implement evidence-based practice to address this deficit. The review of literature will further illustrate the knowledge and communication deficits between patients and providers with code status discussions. The purpose of this study was the creation and evaluation of a standardized discussion/disclosure of code status information and a checklist of topics completed …

Improving Overall Health Outcomes Through Public Health Workforce Development, Zienna Blackwell

Doctor of Nursing Practice (DNP) Projects

Poor health outcomes among South Carolinians, indicated by an overall U.S. health ranking of 42 (America's Health Rankings, 2016) may be the result of an underdeveloped public health workforce. This can be mediated through a thorough assessment of the public health workforce followed by the implementation of a workforce development plan. The purpose of this quality improvement project was to assess the competency level of the South Carolina public health workforce and to develop, implement, and evaluate a workforce development plan to address the weaknesses identified through the assessment process. The Competency Assessment for Public Health Professionals developed by the …

Hypertension: Enhancing Lifestyle Management Through Patient Education And Pender’S Health Promotion Model, Katherine Holcomb

Doctor of Nursing Practice (DNP) Projects

Background: Uncontrolled hypertension is a significant problem in the United States with 46% of hypertensive adults not achieving adequate blood pressure control. Inadequately treated HTN results in increased risk of renal disease, cardiovascular disease, and associated mortality. Interventions aimed at improving blood pressure control have targeted providers, patients, or a combination of providers and patients. Methods: The objective of this project was to enhance lifestyle management of patients with uncontrolled hypertension as measured by patient self-report in post-discharge interviews. The intervention incorporated education for patients on lifestyle management recommendations for hypertension as well as health promotion strategies inspired by Nola …

Evaluating Health-Related Quality Of Life For People With Multiple Sclerosis: A Quality Improvement Project To Promote Peer Support, Nicole Caron

Doctor of Nursing Practice (DNP) Projects

Background: Multiple sclerosis (MS) is an autoimmune disease that impacts the central nervous system, resulting in symptoms of fatigue, numbness, tingling, weakness, dizziness, pain, spasticity, gait disturbance, and depression. How individuals cope with MS may shape adjustment, impacting health outcomes both physically and psychologically. The difficulties that MS may present can result in patients experiencing depression and decreased quality of life. Peer support has been shown to help reduce problematic health behaviors and depression, and to improve medication behavior adherence. While peer support is known to be beneficial in many types of chronic illness, it is unclear whether peer support …

The Impact Of Spinal Manipulation Therapy (Smt) For Nonspecific Low Back Pain In The Military Population: An Integrative Review With Presentation Of The Smt Toolkit To Primary Care Providers, Kelsey Ress

Doctor of Nursing Practice (DNP) Projects

Background: Nonspecific Low Back Pain (NLBP) continues to be a frequent cause for medical care and creates significant direct and indirect costs for the patient and healthcare system. Military members are a unique patient population that is at increased risk for experiencing NLBP. Evidence supports spinal manipulation therapy (SMT) for the treatment of NLBP and clinical practice guidelines (CPG) recommend the use of SMT in the treatment of NLBP. Purpose: The purpose of this integrative review was to determine if SMT is an effective intervention for the military population experiencing NLBP. Presentation and Toolkit: An educational presentation …

Fluoride Varnish Application In The Pediatric Population, Ellen Gnaedinger

Doctor of Nursing Practice (DNP) Projects

Purpose: The United States (U.S.) has a persistent problem of dental caries in primary teeth with a greater prevalence of dental caries found in minority and poor children. The majority of children in the U.S. experience dental caries in their primary teeth by age eight. This problem could be addressed by primary care providers applying fluoride varnish (FV) to children's teeth starting at the age of primary tooth eruption. The causes of dental caries in children’s primary teeth are multifactorial and therefore require multiple interventions. Around the world providers are utilizing FV as an effective and easily administered strategy. This …

Identification And Ptsd Screening Of Military Veteran Patients In Community Healthcare: A Quality Improvement Project, Caitlin Rose Budrewicz

Doctor of Nursing Practice (DNP) Projects

Background: Military veterans are at an increased risk for post-traumatic stress disorder (PTSD) related to their prior military service. Establishing veteran status of patients cared for in civilian healthcare and screening for PTSD will increase the likelihood of identifying symptoms and prompt appropriate treatment. Purpose: The focus of this project is to increase practitioner awareness and knowledge of PTSD in veteran patients as well as to identify and screen veteran patients for PTSD symptoms utilizing the primary care PTSD screen (PC-PTSD). Method: To determine veteran status, patients over the age of 18 years in an internal medicine clinic will be …

Nurse Practitioner Screening For Adverse Childhood Outcomes In Adult Primary Care, Mary B. Shafer

Doctor of Nursing Practice (DNP) Projects

Adverse childhood experiences (ACE) contribute to negative health outcomes. The impact of ACE is linked with physical, mental, and developmental disruption, increase in health-risk behaviors, and increased healthcare utilization. Approximately sixty percent of the US population reports a history of ACE. Despite this growing evidence that ACE is associated with health problems, primary care providers infrequently screen patients for ACE, nor do they consider the impact of ACE on health. The lack of routine screening for ACE in primary care represents lost opportunities to impact health outcomes and promote wellness. The overall goal of this project is to translate research …

Oral Sex And Hsv-1 Knowledge Among College Freshmen Females, Karen Hendry

Doctor of Nursing Practice (DNP) Projects

Herpes simplex 1 (HSV-1) disease transmission to the genitals has life long health consequences for young women. The aim of this DNP project was to assess knowledge among female college freshmen regarding HSV-1 transmission to the genitals during oral sex.

A voluntary and anonymous online survey was e-mailed to 648 female college freshmen using their college e-mail account. A 19% (N=121) survey response rate was achieved. Seventy-three percent of the college females reported receiving oral sex. Ninety-five percent of the college females knew the possible risk of HSV-1 transmission during oral sex. Ninety-six percent of the female students …