Medicine and Health Sciences Commons^™

A Need For A Culturally Congruent Obesity Intervention At A Community Safety-Net Clinic, Claudia D. Rivera-Salas

Doctoral Projects

Background: Obesity is an epidemic in the United States which causes numerous chronic conditions and disproportionally impacts underserved populations. The removal of barriers that prevent active lifestyles such as unaffordable facilities and inaccessibility are of primary importance in promoting a healthy lifestyle.

Objectives: Collaboration with community organizations to increase access to culturally congruent nutrition and exercise classes for underserved Latino/Hispanic patients of a Midwestern safety-net clinic to reduce obesity, increase physical activity, and improve dietary habits.

Methods: Assessment of current practices revealed the need for project development. Six-week nutrition education class and exercise classes were held for eligible patients which …

Using Technology-Driven Patient Communication Appointment Reminders To Improve Uniform Data System Measures In A Federally Qualified Health Center, Ana Torres

Doctoral Projects

Background: Process of meeting Uniform Data System (UDS) measures in a west Michigan Federally Qualified Health Center (FQHC) has several components with different team members sharing responsibility in the process and workflow to document preventative screenings. An evidence-based technology-enhanced patient communication intervention was developed to meet benchmarks for the FQHCs UDS reporting metrics. The purpose of this quality improvement project was to answer the clinical question: Will technology-enhanced communication appointment reminders using automated telephone communication increase rates of screening follow-up visits to improve data reported to UDS at a west Michigan FQHC organization?

Objectives: Increase percentage of screening visits after …

Food Insecurity Among College Students, Alison Hige

Honors Projects

Increasing collegiate education costs results in students today facing greater financial stress. As a result, students have to make difficult choices of how to allocate their monetary resources. Sometimes, students prioritize educational costs over nutrition and health necessities, impacting an individual’s ability to obtain adequate food resources. The purpose of this project was to explore the prevalence and impact of food insecurity among college students. The project included conducting a literature review yielding 26 pertinent articles from the keywords “food insecurity” and “college students.” Food insecurity affects a student’s physical and mental health, along with negatively impacting their scholastic abilities. …

Images Of Nursing From West Michigan: A Photo Essay, Aldina Mahmutovic

Honors Projects

The image of nursing is diverse and complex, with public perceptions influenced by traditional imagery and negative stereotypes. Few recent studies consider how nurses view their professional image. My study aimed to uncover how West Michigan nurses perceive the image of nursing. Approval was given by the local Sigma chapter (Kappa Epsilon at Large), to recruit participants from members, and by Grand Valley's IRB. Via an online REDCap survey, participants submitted an original photo and written narrative. Submissions were searched for underlying patterns using thematic analysis. Themes identified were: (1) nurses establish relationships with unique and vulnerable clients, using their …

Implementation Of An Evidenced-Based Intervention For Pain Management In Lumbar Spine Surgery, Mary R. Draper

Doctoral Projects

Introduction: Spinal surgeries are among the top procedures responsible for the highest degree of post-surgical pain. Opioids are the mainstay of current pain management practices in the post-operative period. In light of the opioid epidemic, increased opioid tolerance, and changes in legislation, there is a calling for alternative strategies in managing acute and chronic pain. The purpose of this project is to answer the following question: Does implementation of an evidence-based intervention for preoperative administration of gabapentin reduce patients’ perception of pain and reduce opioid consumption in those who experience lumbar spine surgery?

Objectives: The goal of this project is …

Evaluation Of A Simulation-Based Nurse Residency Program, Cheri A. Van Wyngarden

Doctoral Projects

Upon completion of nursing school, new graduate nurses sit for licensure examination to demonstrate the minimal knowledge necessary to practice safely as an entry level nurse. Despite satisfactory completion of this examination, many new graduate nurses lack the competency and confidence to safely practice (Jung, Lee, Kang, & Kim, 2016 & Liaw, Palham, Chan, Wong & Lim, 2014). Traditional models of preceptorship with orientation are not adequately preparing new graduate nurses for practice. Nurse residency programs narrow the gap between demonstrated knowledge and competent practice. Varying types of nurse residency programs have successfully replaced traditional nursing orientation methods across the …

Interprofessional Collaboration During Discharge Planning For A Large Midwestern Hospital, Sarah Shepler

Doctoral Projects

Introduction: Interprofessional collaboration (IPC) improves the quality of healthcare delivery. IPC enhances communication during discharge planning, through use of structured daily rounds to reduce readmissions, length of stay (LOS), cost, and mortality. A $240 billion reduction in cost could be achieved with IPC. The Joint Commission, Institute of Medicine, and World Health Organization emphasize use of IPC to reduce errors, improve patient outcomes, and refine transitions of care for patients.

Objectives: The goal of this project was to determine how IPC within structured daily rounds during discharge planning impacts patient LOS and staff satisfaction.

Methods: This quality improvement project was …

Improving Communication Of Asthma Related Care Between Pediatric Primary Care Providers And Schools, Jessica N. Heichel

Doctoral Projects

Introduction: Asthma is a life-altering chronic disease that affects many children throughout the state of Michigan. Evidence-based guidelines recommend a written asthma action plan (AAP) be given to all caregivers of children with asthma. This would include schools, but the plans are not making it there. This project focused on collecting school asthma data and designing a process change at a local clinic to send the plans directly to the schools.

Objectives: The goal of this project was to improve communication between healthcare providers and schools for children with asthma. The objectives were to increase the percentage of children with …

Improving Patient Handover From The Pediatric Emergency Department To The Pediatric Intensive Care Unit, Kathryn Devinney

Doctoral Projects

Patient safety can be at risk during registered nurse handover, particularly when transitioning between high risk areas. According to The Joint Commission (2017), a standardized transition process should be implemented during patient handover. The purpose of this paper was to evaluate the effect of a standardized process with a cognitive aid on handover between a pediatric emergency department and an intensive care unit. Objectives of the project were to decrease conversion time in the emergency department, increase standardized process utilization, and improve patient outcomes, registered nurse perception and satisfaction, and patient proxy satisfaction. This evidence-based quality improvement project took place …

Management Of Distress In Adult Oncology Patients, Lauren Jongsma

Doctoral Projects

Cancer related distress has the potential to negatively impact the health of the patient and their treatment outcome (Grassi, Spiegel, & Riba, 2017). As identification and treatment of distress has a positive impact on patient outcomes; the Commission on Cancer (2016) required distress screening for accreditation. Key stakeholders within a Midwest hospital system expressed a desire for the improvement in the current state of the distress screening. Thus, the scholarly paper describes the key attributes of the organizational assessment, a literature review on evidence-based distress screening tool and a quality improvement project. The Promoting Action on Research Implementation in Health …

Screening For Social Determinants Of Health In Diabetic Patients Served In Primary Healthcare Centers, Hewan K. Chekol

Doctoral Projects

Background: Social Determinants of Health (SDOH), such as food, transportation, housing, and financial status, plays a significant role in a diabetic patient’s health care outcome. However, primary healthcare centers lack a systematic method of identifying patients with unmet social needs in order to provide appropriate referrals to community resources.

Objective: This project seeks to improve the screening methods of SDOH in a midwestern federally qualified primary healthcare center by incorporating an evidence based SDOH screening tool. This SDOH screening tool is tailored towards diabetic patients.

Method: Kotter’s Eight Step Change model guided the implementation process of this quality improvement project. …

Nurse Care Manager Impact On Type 2 Diabetes Mellitus At A Rural Primary Care Practice, Patrick Joswick

Doctoral Projects

Background: Type 2 Diabetes Mellitus is a common diagnosis managed in the primary care setting. Patients with an uncontrolled state of the condition are most vulnerable to develop complications from the disease. Consequently, type 2 diabetes remains as the leading cause of end stage renal disease and nontraumatic limb amputations.

Objectives: To improve type 2 diabetes quality measures, improve documentation of quality measures, increase the continuity of care, and create a streamlined workflow and communication within an interdisciplinary team.

Methods: Quality improvement project to establish multifaceted management of type 2 diabetes. Data on the management of care was gathered pre-/post-implementation …

Implementation Of An Evidence Based Screening Protocol To Improve The Diagnosis Of Dementia In A Home-Based Primary Care Setting, Lauren Liesbeth Sutton

Doctoral Projects

Dementia is a major public health concern that is both debilitating and deleterious to those afflicted with its various forms. The number of those living with dementia is increasing exponentially as the population continues to rise, with 46.8 million people worldwide currently afflicted with dementia (Chow et al., 2018). Dementia causes cognitive impairment that is severe enough to affect everyday function (Chow et al., 2018). The impairment and disability resulting from dementia indicates a significant health problem in primary care. Findings from research studies indicate that prophylactic and periodic screening for dementia can heighten provider suspicion and translate into earlier …

Increasing Utilization Of Cognitive Behavioral Therapy To Reduce Morbid Obesity In A Primary Care Setting, Erin J. Mccue

Doctoral Projects

Background: Obesity among adults is characterized by a body mass index (BMI) of 30 or higher. The impairment and disability resulting from obesity indicates a significant health problem that is often seen in primary care settings. Research indicates that cognitive behavioral therapy (CBT) is an underutilized, but extremely beneficial intervention that may support individuals in achieving weight loss. Adults suffering from obesity with or without comorbid conditions such as psychiatric disorders (e.g. anxiety and depression) have benefitted from CBT.

Purpose: To implement the increased utilization of CBT in the adult population with obesity and depression or anxiety in a primary …

Using The Rapid Assessment For Adolescent Preventive Services (Raaps) To Screen For Risk Taking Behaviors Of 13 To 18 Year-Olds In A Regional Family Practice Office, Megan E. Carpenter

Doctoral Projects

Risk-taking behaviors are a significant problem in the adolescent population and the three leading causes of mortality for adolescents are suicide, homicide, and unintentional injury (Heron, 2017). National organizations support screening for adolescent risk-taking behaviors and research demonstrates effectiveness of screening. This quality improvement (QI) project implemented the Rapid Assessment for Adolescent Preventive Services (RAAPS) screening tool at a regional family practice office as a vehicle to accomplish the objectives of increased identification of, and intervention for, risk-taking behaviors in adolescent patients. Included in the methods were baseline and implementation chart reviews that were used to assess the change in …

Implementation Of The Vaccines For Children Program In A Midwest, Urban Clinic Dedicated To The Underserved Population, Akmal Saydazamov

Doctoral Projects

Background: Low immunization rates weaken herd immunity and endanger children. The Safety Net Health Clinic (SNHC) study site serves an underprivileged and refugee population with significantly lower than ideal coverage. Series completion disparities persisted after control for demographic, access-to-care, poverty and language effects (Varan et al, 2016).

Objectives: SNHC implemented the Vaccines for Children (VFC) program in order to increase the vaccination rates among the underserved population.

Methods: As an efficacy study, the project focused on three major areas in the VFC implementation – cost, staff preparedness and patient need. Cost was determined by utilizing electronic medical records (EMR) and …

Development Of A Process For Adoption And Attainment Of Pcmh Recognition Requirements For An Urban Primary Care Clinic, Jamie L. Hendricks

Doctoral Projects

The Centers for Disease Control and Prevention (2017) reported that in 2016, healthcare expenditures in the United States totaled 17.9% of the gross domestic product. Unfortunately, care quality is not reflective of the high costs of care. Models of care delivery like the patient centered medical home (PCMH) have shown promise in addressing these concerns.

This project focused on program development for PCMH adoption at an urban clinic in an effort to improve financial stability and remain competitive. The purpose was to propose a plan for adoption and attainment of PCMH recognition requirements for an urban primary care office.

The …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Identifying Gaps In Care In The Geriatric Trauma Patient With Rib Fractures, Kathy A. Crystal

Doctoral Projects

Introduction: Rib fractures in the geriatric patient can be life altering. Across the country trauma centers are caring for an increased volume of geriatric patients aged 65 years and older (Ali-Osman et al., 2018). The geriatric patient with thoracic injury has the second highest mortality rate among the trauma population in the United States (Mentzer et al., 2017). The assessment of the patient is key to identify critical changes due to high risk of adverse events from rib fractures. Despite efforts to standardize the assessment and care provided to the patient with rib fractures, a lot of variation occurs. Research …

Nonalcoholic Fatty Liver Disease And The Pnpla3 Gene, Lori Houghton-Rahrig, Debra Schutte, Jenifer I. Fenton, Jennifer Awad

Peer Reviewed Articles

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic …

An Evaluation Of A Nerve Block Protocol In Patients With Hip Fractures, Jenna Buchman

Doctoral Projects

BACKGROUND/PURPOSE: Pain management for hip fracture patients in the time before surgery is crucial. Literature highlights the success of local, single injection nerve blocks to aid in preoperative pain management. A local hospital implemented a preoperative, single injection nerve block protocol in March 2018. This quality improvement project investigated: (1) organization protocol compliance, and (2) if the preoperative single injection nerve block protocol reduces hip fracture pain, use of systemic opioid analgesics, decreases incidence of adverse opioid effects, and reduces cost of care.

SUBJECTS: Patients ages 18 and older admitted with the primary diagnosis of an operable isolated hip fracture …

An Implementation Toolkit For Increasing Breastfeeding Sustainability, Regina Kirwin

Doctoral Projects

Introduction: African American women have the lowest rates of breastfeeding in the United States compared to other racial and ethnic groups (DHHS, 2016). Peer support increases breastfeeding rates (Shakya, 2017). An evidence-based implementation toolkit will provide key stakeholders the information and skill development needed to successfully implement and sustain peer support programs geared toward increasing breastfeeding rates for African American women in West Michigan. The purpose of this paper is to disseminate the quality improvement process used to develop an evidence-based toolkit guided by a secondary data analysis from research data collected in a previously implemented peer mentor program.

Objective: …