Medicine and Health Sciences Commons^™

Increasing Breast Cancer Screenings In The New American Population, Tuhina Venkatayogi Mph, Bs, Rn, Erin Leighton Dnp, Aprn, Fnp-Bc

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

Purpose: Breast cancer poses a significant health risk globally, with routine screenings pivotal for early detection. The New American population in Vermont face many barriers to accessing mammogram screenings and have a 0% participation rate in breast cancer screening, thus necessitating targeted interventions. The purpose of this project was to improve mammogram participation among New Americans by at least 15% by January 2024.

Methods: The intervention at a New American clinic included an educational infographic presented during initial health center visits, supplemented by tangible pamphlets. Patient understanding was assessed through teach-back questions. Appointment scheduling was facilitated during the visit, with …

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 …

Neonatal Abstinence Syndrome: Assessing Practice And Challenges In Vermont Hospitals, Robyn Santor, Molly Rideout

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

Background: Neonatal abstinence syndrome (NAS), characterized by tremors, vomiting, diarrhea, fever, diaphoresis, irritability, high-pitched cry and tachypnea, affects some newborns with prenatal opioid exposure. In 2018, the rate of opioid use amongst Vermont’s pregnant women was reported highest in the nation, with a rate of infants developing NAS significantly higher than the national average. Purpose: This project assessedthe use and impact of evidence-based best practice when caring for infants with NAS in Vermont’s birth hospitals. These included utilization of the Eat, Sleep, Console model, non-pharmaceutical interventions, and volunteer cuddler programs. Methods: This project adopted a mixed method approach, using …

Eras: Improving Surgical Experience In Traumatic Hip Fracture Surgery, Kristen Knight Dnp(C), Marcia Bosek, Dnsc

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

Utilizing Enhanced Recovery After Surgery (ERAS) Protocol to Improve Perioperative Outcomes for Patients Sustaining Traumatic Hip Fracture.

Kristen Knight, DNP(c), RN

Project Team:

Project Advisor: Marcia Bosek, DNSc, RN

Site Mentor: Kat Gouldy, MSN, RN

Abstract

Background: Enhanced Recovery After Surgery (ERAS) pathways have improved perioperative outcomes for patients undergoing surgical care for traumatic hip fracture without increasing rates of complication or mortality. These protocols are not instituted at all hospitals.

Purpose: Improve perioperative outcomes for patients sustaining traumatic hip fracture by (1) creating an evidence-based pathway, ERAS Orthopedic Pathway (ERAS-OP), to guide perioperative care for traumatic hip fracture, (2) …

Creation Of A Parent-Directed Toolkit To Prevent Youth Vaping, Corinne Webb

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

Purpose: Vaping rates among adolescents are at an all-time high. Misperceptions about the harms of vaping may limit parents’ ability to impact youth vape use. This project developed and tested an evidence-based toolkit to educate parents of adolescents about the risks of vaping.

Methods: The toolkit’s creation was informed by published evidence and multimedia content delineating the scope of the vaping crisis. The toolkit was reviewed and revised by content experts. Pre- and post-implementation assessments were created and tested with faculty members, public health professionals, teachers, and parents. Assessments were utilized to evaluate parental vaping knowledge before and after implementation …

Implementing Sbirt In A Critical Access Emergency Department, Warren P. Mcdermott, Mary Val Palumbo Dr.

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

Purpose: Universal screening and brief intervention with referral to treatment (SBIRT) has become best practice for emergency departments (EDs) over the last two decades. Given the prevalence of alcohol use and the subsequent health impacts of drinking, EDs are well positioned to be on the front line of screening for risky drinking. The available literature is clear in its consensus that universal screening for alcohol use in the ED is critical to identifying people at high risk for drinking and improving health outcomes.

Aims: This project aimed to implement an SBIRT process in a critical access ED. To achieve this …

Implementation Of Adverse Childhood Experiences Screening Tool For Providers In Primary Care Pediatrics, Morgan P. Via

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

Purpose: Adverse childhood experiences (ACEs) are recognized by the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) as contributing factors to poor health outcomes in childhood and beyond. Many pediatric providers are aware of the importance of ACEs, yet most do not participate in routine screening. The goal of this project was to implement ACEs screening at a semi-rural pediatric primary care office, aiming to screen 50% of eligible patients over 6 weeks. A secondary goal included increasing provider knowledge of and comfort with discussing ACEs through participation in an online training module.

Methods: Families …

Increasing Inpatient Access To Palliative Care Consultations: A Pilot Quality Improvement Study, Tyler Wilson Dnpc, Rn, Jason Garbarino Dnp, Rn, Cnl

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

Purpose: Palliative care is focused on providing relief of symptoms and the stress of chronic illness, providing an improved quality of life for both patient and family (CAPC, 2020). Eighty percent of consumers who receive information about palliative care say they would choose it for themselves or their loved ones, however, 60% of those consumers never actually receive those services (CAPC, 2020; Compton-Phillips, 2020).

Methods: This quality improvement study aimed to increase the number of appropriate palliative care consultations on an inpatient general medicine unit by designing and implementing a nurse-driven protocol and palliative screening assessment. Staff nurses were educated …

Txt4toc: Improving The Transition Process For Youth With Special Health Needs, Rebecca Pickering

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

Purpose: Pediatric patients who have complex medical needs require guidance and education through a transition process from their pediatric to adult specialty provider. Without support throughout this process, youth are at risk for problems with self-management and medication adherence, have higher emergency room use and hospital admissions, and have a higher cost of care. Utilizing a texting platform is a method that has been replicated in research of adolescents and shown to be an effective way to provide education. Nurses and nurse practitioners can help facilitate this process by leveraging established relationships with patients and families.

Methods: A 16-week texting …

Improving Mental Health Documentation Through Education: An Intervention For Level Of Care Utilization System (Locus) Use In Psychiatric Crisis Placement, Lauren Ozimek

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

Purpose: The Community Mental Health Act (1963) created crisis stabilization units to lessen burdens of emergency departments addressing psychiatric crises. Crisis stabilization units – including the project site – evaluate treatment efficacy via assessments including the Level of Care Utilization System (LOCUS). The LOCUS is totaled into a composite score, expected to decrease at treatment completion. The project site has not consistently seen LOCUS scores decrease at completion. The project’s purpose was to improve use of a clinical assessment tool to reflect treatment and progress for patients utilizing crisis stabilization programs. A secondary aim was to increase incidence (75%) of …

Improving Knowledge And Competency Of Self-Monitored Blood Pressure In Older Adults, Edna Koh Hwa Tang, Melanie Keiffer Dnp, Aprn, Anp-Bc, Cne

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

Background. The risk for developing uncontrolled hypertension increases with age. Hypertension remains under-controlled and underdiagnosed in rural areas. This trend is exacerbated by the COVID-19 pandemic due to decreases in primary care visits, increases in telehealth visits, and a significant decline in assessment of blood pressure. Evidence reveals that telemedicine in conjunction with self-monitored blood pressure (SMBP) are proven tools to support patients and providers in the remote management of hypertension.

Purpose. This project aimed to improve utilization of self-monitored blood pressure (SMBP) for management of hypertension in older adults (65 years and older) and accuracy of self-reported …

Oncology Nurse Hazardous Drug Safe Handling Competencies, Jacob N. Woller

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

Purpose: Healthcare workers are potentially exposed to hazardous drugs (HDs) in the workplace, especially with chemotherapeutics used in oncologic treatment. Exposure to HDs increases the risk of adverse health effects. Personal protective equipment (PPE) as one control to prevent exposure. A Northeast academic medical center required implementation of annual competencies on HDs to comply with national standards detailed in United States Pharmacopeia (USP) Chapter 800. This project sought to evaluate the effectiveness of this HD competency and evaluate the PPE practices of healthcare workers who are frequently involved with HDs

Methods: A hands-on HD annual competency was developed …

Using Audit And Feedback To Improve Compliance To Medication-Assisted Treatment Recommendations, Jacob Burns, Melanie Keiffer

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

Using Audit and Feedback to Improve Compliance to Medication-Assisted Treatment Recommendations

Jacob Burns, DNPc, RN

Project Advisor: Melanie Keiffer, DNP, APRN, ANP-BC, CNE

Abstract

Background: Of the 111 opioid deaths reported in the State of Vermont in 2019, 30 were found to be prescription opioid-related and accidental. Medication Assisted Therapy (MAT) programs support patients with substance use disorders, promoting recovery and preventing overdose. Vermont uses the “Hub and Spoke” model to increase the availability of MAT for patients with OUD (Opioid Use Disorder) by increasing the number of primary care providers who prescribe buprenorphine. Hubs are the specialty opioid treatment …

The Vermont Safe Infant Sleep Project: Evaluation Of An Online Learning Module, Brigid Meehan-Brese, Jean Pelski Phd, Aprn, Nnp-Bc

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

The Vermont Safe Infant Sleep Project: Evaluation of an Online Learning Module

Brigid J. Meehan-Brese DNPc, RN

Rosemary Dale Ed.D, APRN, Julie Parent MSW, and Jean Pelski PhD, APRN, NNP-BC

Abstract

Background: In the United States, sudden unintended infant death syndrome (SUIDS) is a leading cause of infant mortality. Accidental suffocation, and strangulation in bed (ASSB) deaths are the third leading cause of postnatal deaths (CDC, 2021). The Vermont Safe Infant Sleep Project is a collaborative effort focused on standardizing evidence-based practice recommendations for nurses to support safe infant sleep practices. An online learning module for registered nurses was developed …

Increasing Utilization Of The Delirium Prevention Protocol In Post Cardiovascular Surgery To Improve Quality And Safety Of Healthcare, Kristin Luce

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

Abstract:

Background and Objectives: Post-operative delirium (POD) is the most common complication seen following surgery in older adults. Two-thirds of delirium cases are diagnosed late or missed in everyday practice across health care settings which can lead to a variety of long-term complications. POD prevalence can be reduced within inpatient practice settings by utilizing established screening tools, such as the Confusion Assessment Method (CAM). This project aimed to increase nurse screening of delirium and provide education on POD to nursing staff on the post-cardiovascular surgery unit to increase utilization of the delirium prevention protocol.

Methods: Educational sessions provided to nursing …

Evaluating The Indirect Effects Of A Community-Based Child Obesity Prevention Program On Adult Health Behaviors, Emily K. Rocheleau

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

Purpose: Community-based intervention (CBI) programs aim to change individuals’ behaviors to reduce the risk of chronic disease, often by addressing factors that contribute to obesity. To provide information for improving interventions, program evaluation is needed. In Franklin and Grand Isle Counties, childhood extreme obesity decreased where a child-targeted, obesity prevention focused CBI was implemented. It has been shown that these programs can have an indirect effect on parent health/body mass index (BMI), but it is unclear if indirect effects of such programs have an impact on adult BMI and related health behaviors. The purpose of this project was to determine …

Evaluating & Improving Adolescent Mental Health Accessibility In Vt, Kaitlyn A. Surwilo

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

Background: Rates of anxiety among adolescents are increasing. Providers at a rural Vermont clinic identified the need for an evidence-based process to use when adolescents screen positive for anxiety. Reports from providers regarding the challenges of referring to mental health providers called the accessibility of care into question.

Purpose: The purposes of this quality improvement project are to create an evidence-based toolkit for adolescent anxiety and assess the accessibility of mental health care in Vermont.

Methods: A literature review identified mindfulness and exercise as effective tools for managing anxiety. An anxiety toolkit was designed for adolescents aged 11-18 …

Care Coordination And Empowerment In People With Type 2 Diabetes, Erik M. Wilson

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

1. Background: In 2018, approximately one in seven Americans had been diagnosed with Type 2 Diabetes, a number that is projected to increase to one in three by 2050. Approximately 40% of individuals with Type 2 diabetes develop long-term complications, accounting for one-in-four healthcare dollars spent in the United States. Current initiatives supported through Accountable Care Organizations place an emphasis on improving the quality of care delivered in chronic medical problems such as diabetes to optimize patient outcomes, moving away from the traditional fee-for-service. One cornerstone of improving quality of care is care coordination and education.

1. Methods: Utilizing the Plan-Do-Study-Act methodology …

Improving Sexual Health Knowledge In College Students, Emily A. Wasserman

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

Background: Since 2014, the rates of chlamydia, gonorrhea, and syphilis have increased in the United States with young people (ages fifteen to twenty-four), gay and bisexual men, and pregnant women being some of the most vulnerable groups for these sexually transmitted infections (CDC, 2014, 2018). In parallel, only 51.4% of college students have a moderate level of STI knowledge (Adebayo, Anderson, & Wardecker, 2020).

Objectives: The aim of this quality improvement project was to implement a sexual health product ordering system and initiate an education platform to (1) improve sexual health knowledge by 25% by December 2021 and (2) provide …

Behavioral Intervention Education For Pediatric Functional Constipation: A Feasibility Project, Meredith Brady, Jean Pelski Ph.D., Aprn, Nnp-Bc

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

Background: Functional constipation (FC) is a common condition frequently seen in pediatric primary care, with an estimated median prevalence of 16% among pediatric patients (Mugie et al., 2011). Standard care for this condition is typically limited to laxative therapy, however evidence supports improved outcomes for patients who also receive behavioral intervention education. Purpose: The purpose of this quality improvement study was to assess the feasibility of implementing a standardized intervention strategy in a primary care setting for pediatric patients with FC to inform a future pilot study. Methods and interventions: This feasibility study was completed in three steps. 1) A …

Knowledge Of Guidelines On Pediatric Patients In Foster Care, Katharine A. Stones

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

Purpose: The American Academy of Pediatrics (AAP) identifies children living in foster care (CFC) as a special health care needs population due to a high prevalence of health conditions. To address these disparities, the AAP released guidelines regarding the timeliness of medical assessments for CFC. Lack of recognition of the guidelines further widens health disparities experienced by this population. This project’s purpose was to 1.) Improve pediatric providers’ and nurses’ knowledge of AAP guidelines by at least 50% and 2.) Initiate acknowledgment by participants that CFC represent a special health care needs population.

Methods: Following conduction of qualitative interviews and …

Adolescent Suicide Prevention Via Parental Education, Junelle Shepard, Mary Val Palumbo

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

Purpose. Up to 24% of children from the ages of 12 to 17 have reported suicidal ideation, with 7-11% reporting at least one suicide attempt in the past 12 months (Hetrick, 2017). In a study by Jones et al (2019) over 50% of parents were unaware their child was exhibiting suicidal ideation. This project aims to increase community awareness of suicidal ideation and teach community members how to talk with adolescents about this sensitive topic.

Methods. Five online training sessions were offered in Fall 2021, with each session lasting 90 minutes. Using Smith et al.’s Suicide Knowledge and Skills Questionnaire, …