Using Lifestyle Educational Intervention To Decrease Blood Pressure Reading Amongst African American Adults, Catherine Madu

Dissertations

Hypertension or high blood pressure is a global epidemic and a major public health challenge in the United States. Hypertension increases the risk of cardiovascular disease, stroke, and renal failure. The disease disproportionately affects African Americans (AAs) and is a leading cause of morbidity and mortality in this ethnic group. Effective management of hypertension decreases complications from the disease. The purpose of the clinical scholarly project (CSP) was to decrease blood pressure readings amongst AA adults, ages 18 to 65 years old using educational intervention on lifestyle modifications. A convenience sampling of 20 AA (n = 20) adult participants was …

The Usage And Impact Of Outpatient Commitment Orders On Suicide And Suicide Attempt Rates In Mississippi, Sam Mauldin

Dissertations

Rates of self-harm and suicide in the United States have not decreased since 1980 and remained relatively constant through the start of the 21^st Century. The most recent data indicate that suicide rates in the United States have risen by about 2% a year from 2006 through 2016, although suicide rates have decreased in other countries during the same timeframe. Finding a viable intervention to slow rates of self-harm and suicide is needed in the United States. The need for closer patient observation has been cited as an underutilized intervention for the reduction of attempts of self-harm and suicide. …

A Quality Improvement Study On Missed Appointment Management In Primary Care, Aunye' Dina Amos

Dissertations

Abstract

Problem: Patients who miss appointments have poorer health outcomes and increase costs for medical care. The purpose of this quality improvement study was to evaluate the effects of missed appointments on patients’ outcomes for diabetes mellitus, and resulting financial losses to a private primary care practice.

Method: A quality improvement initiative with a retrospective review of patients over a six-month period in 2018 (before) and 2019 (after a missed appointment fee was implemented). All adult patients, aged 18-92 years, were included. For those with diabetes, a HbA1c for each patient who kept or missed their appointment was recorded.

Results: …

Improving Access To Mental Health Care With Nurse Practitioners, Jessica Whelan

Dissertations

Problem: Over 40% of those with mental illness are untreated since the supply of psychiatrists does not meet the demand. The psychiatric mental health nurse practitioner (PMHNP) may be an adjunct in providing those services. The purpose of this quality assurance study was to evaluate outcomes of care between a PMHNP and a psychiatrist (medical doctor [MD]).

Methods: An observational, descriptive design with a retrospective medical record review of adult patients over a six-month period in a suburban, Midwestern, privately owned psychiatric practice.

Results: A total of 787 individual patients encountered at least one visit (N=787) although 3,679 …

Impact Of A Web-Based Instructional Module Of Alzheimer’S Disease Within Seven Content Knowledge Domains, Joyce Haynie

Dissertations

Abstract

Alzheimer’s Disease (AD) has been classified as the most common form of dementia. Primary health care providers are usually the first clinicians to whom individuals present with symptoms of dementia. By 2050, it is expected that as many as 13.8 million Americans will be living with AD, and millions more will be placed in the challenging role of providing care for these individuals. However, studies continue to show that dementia is often underdiagnosed and under detected. The purpose of the study was to systematically inquire about the impact of AD education on level of knowledge about AD among primary …

Evaluating Controlled Substance Documentation In An Electronic Medical Record, Delora Brooks

Dissertations

The Centers for Disease Control and Prevention (CDC) directives issued in 2016 gave guidelines for safely prescribing opiates; however, primary source discussions about methods used for documenting opioid and controlled substance monitoring within an electronic medical record (EMR) are limited (Hussain, Nelson, Polston & Zheng, 2019). This leaves individual providers to determine the appropriate way to document. Inconsistent documentation may not protect providers or organizations from regulatory, civil or criminal liability. As stated by Raveesh, Nayak & Kumbar (2016), “The best way to handle medico-legal issues is by preventing them”. Even with the advent and widespread use of EMRs, documentation …

Fathers' Experiences With Their Premature Infants Or Unhealthy Neonates, Lisa Cummings

Dissertations

Author: Lisa Cummings PhD RN

Fathers’ Experiences with Their Premature Infants or Unhealthy Neonates

Purpose and Background/Significance: Fifteen million babies worldwide are born prematurely each year, impacting a multitude of fathers. The importance of an early close father-infant relationship has been identified as central for the development of the child. Fathers influence on a child’s emotional and cognitive development and their physical well-being and health. Many times, the Neonatal Intensive Care Unit (NICU) is the initial contact environment between a father and his premature infant. Studies have shown that the NICU can be a stressful environment for parents, producing emotional …

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

A Survey Of Healthcare Workers On Safe Patient Handling And Mobility Resource Availability, Utilization, And Adherence, Kimberly Waltrip

Dissertations

The purpose of this study was to examine the current status of safe patient handling and mobility—specifically resource availability, utilization, and adherence to established safe patient handling and mobility standards—and measure any relationships among these factors. This study builds on the reliability and validity of the adapted American Nurses Association’s (2016) Safe Patient Handling and Mobility Self-Assessment Resource. Responses came from a one-shot survey of healthcare workers in direct patient care across several private and Veterans Health Administration healthcare organizations in the Midwestern United States. The risk of injury is higher in patient handling than in many other professions; …

A Quality Initiative To Reduce Pneumonia Readmissions And Mortality In Older Adults, Terri Morris

Dissertations

The United States (U.S.) healthcare system journey for making improvements in the quality and value of healthcare continues. Hospital organizations are required to compose and make publically available their health quality outcome data. The publication transparency and increased availability of local, regional and national health quality metrics, including readmission and mortality rates, to governmental agencies, health plans, investors, other hospitals, providers and potential patient and families’ knowledge, creates a competitive pressure for a hospital to assure their quality outcomes data are the best. Despite breakthrough improvements using innovative care models that target vulnerable and potentially high cost of care areas …

Education-Based Interventions Effects On 30-Day Readmission Rates For Patients With Copd, Gina Hand-Eoloff

Dissertations

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing education-based program for Chronic Obstructive Pulmonary Disease (COPD) and its effect on 30-day readmission rates in one hospital in rural Missouri.

Method: A retrospective chart review was completed on 493 patients with an inclusive diagnosis of COPD from June 1, 2018, to March 31, 2019, using a cohort study design and a two-sample t-test analysis. Additional variables were analyzed to determine if there were predictive factors of an elevated risk of readmission.

Results: The two-sample t-test reveals there is no statistically significant difference between the rates of readmission …

A Vaccine Administration Training Program To Increase Adolescent Vaccination Rates, Claire Jensen

Dissertations

Abstract

Immunizations have been proven to control life-threatening diseases. Often Registered Nurses (RNs) administer vaccines but are unsure how to discuss vaccines with vaccine hesitant patients. Missouri’s adolescent vaccination rates are below its neighboring states. This initiative’s purpose was to increase adolescent vaccine administrations at a Missouri County Health Department (MCHD).

This quality improvement initiative had an observational, cross-sectional, descriptive design. RNs employed at three MCHD clinics attended an adolescent vaccine administration training program (VAT) and completed pre-/post-tests regarding the Advisory Council on Immunization Practices recommendations. Medical record reviews from March 1-April 30, 2018 and March 1-April 30, 2019 compared …

Barriers To Mental Health Treatment In Patients Referred By Primary Care, Rebecca Palmer

Dissertations

Problem: Limited access to mental health treatment is one of many potential barriers to treating mental illness in the United States. Where resources are readily available, reportedly high no-show rates for established mental health appointments suggests further investigation is necessary to identify frequent barriers within that population. This was a quality improvement project to identify common themes in patient-reported barriers to care.

Methods: A 4-question phone survey was offered to individuals that did not appear at their mental health appointment. Data was analyzed to identify the most commonly reported barriers to mental health treatment. Additional data collected includes reported history …

Nitrous Oxide Use For Minor But Painful Pediatric Procedures, Samantha Kremer

Dissertations

Problem: Nitrous oxide (N₂O) is used for mild to moderate pain control and anxiolysis. Registered nurses (RN) as providers of N₂O administration may decrease the number of missed opportunities for pain control or anxiolysis. The purpose of this quality improvement initiative was to evaluate the type of procedures and rate of N₂O administration by providers, and cost difference between them.

Method: A descriptive, cohort-design for pediatric patients in the Imaging and Sedation Department between October through November of 2017 and 2018. Data was compared between physicians in 2017 and either a physician or RN …

Race-Based Trauma Care Training For Veteran’S Health Administration Nurse Practitioners, Vanessa Loyd

Dissertations

Abstract

Problem: Trauma informed care has become a priority for persons exposed to psychological, physiological, emotional consequences as a result of traumatic experiences. Veterans are from different cultures, including gender, race, religion, sexual orientation and other social groups. The Veterans Health Administration (VHA) is responsible for the health of this culturally diverse patient population. Healthcare providers without any prior military experience may experience difficulty obtaining an accurate history and physical exam due to the military’s cross-cultural environment. The project aim was to increase confidence and competence in race-based trauma care by incorporating training into a new acute care fellowship …

A Rural Telehealth Objective Structured Clinical Examination, Devon Schlottach

Dissertations

Problem Rural healthcare consumers experience increased health disparities, especially when accessing health care. The use of telehealth to improve access has become an essential competency for nurse practitioner (NP) students. This study evaluated NP students’ confidence and competence of rural social determinants of health (rSDOH) before and after a telehealth simulation.

Methods A descriptive, cohort design was used to review NP students’ pre- and post-surveys, written case studies, and a video-recorded telehealth OSCE for a patient living in a rural area.

Results Student self-rated knowledge of rural health care did not improve despite didactic learning and simulation (z = …

Adult-Geriatric Acute Care Nurse Practitioner Fellowship For The Veterans Health Administration, Karen Scaglione

Dissertations

Problem: Nurse practitioner (NP) fellowship programs assist the novice NP in transitioning from a traditional nursing role to advanced practice. The Veteran’s Health Administration (VHA) utilizes a NP primary care fellowship program. An acute care fellowship may assist with role transition, confidence and competence for acute care NPs. The purpose of this evidence-based pilot project was to develop a transition to practice acute care fellowship program at a Midwestern VHA hospital.

Methods: A prospective, descriptive design utilizing a convenience sample of senior adult-geriatric nurse practitioner (AGNP) students during a pilot study of an acute care fellowship program. Outcome measures …

Management And Support Of Uninsured Patients With Diabetes Type Ii Within A Nurse Managed Clinic, Emma Spencer

Dissertations

The purpose of the project was to improve the quality of care for the uninsured, Type II Diabetics residing in a Midwestern urban underserved community. Community Health in Partnership Services (CHIPS) was a nurse-managed clinic, located in that area, that sought to lessen the burden of being uninsured. An annual fee of $35.00 allowed an uninsured community member access to a variety of different health care providers including specialists. In order to utilize this health care team efficiently, it was necessary to implement nurse-led care coordination for patients diagnosed with Type II Diabetes. This quality improvement project followed the Plan …

Increasing Nursing Competence And Confidence During Obstetric Emergencies Through Simulation: A Quality Improvement Project, Tram Wallen

Dissertations

Problem: This quality improvement project aimed to improve the knowledge and confidence of the mother/baby nursing staff during postpartum hemorrhages through in situ simulation. PPH is a leading cause of maternal death. Hospitals across the U.S. lack a standard approach to managing obstetric emergencies; the complications of childbirth are often identified too late. Multidisciplinary simulation-based team training has been associated with improved outcomes in obstetrics.

Methods: A convenience sample of 26 registered nurses (RNs) that care for postpartum patients attended a one-hour instructor-led presentation followed by in situ simulations of postpartum hemorrhage. A knowledge assessment and confidence survey were administered …

Evaluating The Delivery Of Diabetes-Related Care Among The Asian Population, Lyly Bui

Dissertations

Purpose: This project evaluated current practices for Type 2 diabetes mellitus (T2DM) screening and management among Asian Americans (AAs) presenting to a primary care clinic and determined whether these practices adhered to the American Diabetes Association (ADA)’s 2018 guidelines.

Methods: A retrospective chart review was performed to extract data from clinical case records of AAs who visited the Vietnamese Health Center (VHC) between November 1, 2017 and November 1, 2018. Descriptive statistics were utilized to analyze the data.

Results: Of 173 charts reviewed, 76.3% of AAs had no previous T2DM diagnosis and 23.7% had a previous diagnosis. Among those without …

Decreasing Opioid Overprescription Following Outpatient Gynecology Surgery, Monica Kistler

Dissertations

Problem: Opioid abuse may be a result of overprescribing opioids. There are no opioid prescribing recommendations for minor gynecologic surgery. As a result, there is a wide variation in prescribing practices at a privately-owned surgery center where excessive opioid prescription occurs.

Methods: A quality improvement initiative with a descriptive, cohort design. A retrospective review of medical records and telephone surveys over three months resulted in the development of a series of posters describing prescription data for three procedures: hysteroscopy dilation and curettage (HDC), uterine ablation (UA), and laparoscopy (LAP). The trends and changes in opioid prescription practices were displayed throughout …

Depression Screening In Antepartum Females, Michelle Burk

Dissertations

Problem: Perinatal mood disorders, including depression, affects one in five pregnant or postpartum females. The American College of Obstetricians and Gynecologists (ACOG) and the US Preventative Task Force (USPTF) recommended screening for depression at least once during the antepartum and postpartum periods. The purpose of this quality improvement initiative was to introduce depression screening using the patient health questionnaire (PHQ) in antepartum women in a Midwestern private OB-GYN practice.

Methods: An observational, descriptive, cohort design utilizing a retrospective record review was used to evaluate for PHQ depression screening. A convenience sample of antepartum patients at/or around 36-weeks gestation was studied. …

Screening For Sexually Transmitted Infections In Adolescents, Millicent Palacios

Dissertations

Abstract

Problem Adolescents are contracting sexually transmitted infections (STIs) with half of all new STIs occurring in those aged 15-24 years old. The American Academy of Pediatrics, recommended all sexually active adolescents be screened for STIs. Incorporation of a sexual behavior assessment may assist providers with identifying STI risk.

Methods A descriptive design comparing three cohorts of adolescents presenting for a well-exam. The cohorts analyzed were: urine screening on all adolescents, urine screening for only those reporting sexual activity, and a self-administered sexual history questionnaire tool, based on the HEEADSSS psychosocial assessments.

Results The majority (97%), of all three cohorts …

Primary Care Delays In Underserved Areas: A Strategic Plan To Improve Access To Care, Debra Connell-Dent

Dissertations

Hypertension (HTN) and Diabetes Mellitus Type 2 (DM2) are two chronic conditions contributing to morbidity and mortality. 23.1 million people have DM2 and 7.2 million people have it an are undiagnosed in the U.S. During 2015-2016, the prevalence of HTN was 29.0% and increases with age (CDC, 2018). This purpose of this article was to discuss the benefits of developing a Transition Clinic (TC) in a highly traveled metro transit area and the development of a strategic plan on implementing this project, as well as the barriers that may be encountered when implementing such a clinic similar to this. A …

Depression In Hiv-Positive Individuals Living In A Residential Housing Community, Danielle Njeri

Dissertations

Problem: Depression is the most prevalent psychiatric disorder among individuals living with HIV. Depression rates are three times greater than those found in the general population . Undiagnosed and untreated depression can have a negative effect on the management of HIV infection, resulting in increased mortality and a poorer quality of life. The purpose of this quality improvement initiative was to assess the incidence of depression in HIV-positive individuals living in a residential community.

Methods: A prospective, descriptive, cohort design. Convenience sample of HIV-positive adult residents living in an HIV residential community. The nine-question patient health questionnaire (PHQ-9) …

Reducing Cautis In A Neurological Icu, Claire Mckee

Dissertations

Catheter-associated urinary tract infections (CAUTIs) are the primary source of infection in patients with urinary catheters and are the fourth leading cause of healthcare-associated infection. Because indwelling urinary catheters are not completely avoidable in hospitalized patients, it is crucial to utilize evidence-based research to prevent CAUTIs. A urinary catheter maintenance bundle is one way to reduce CAUTI rates in hospitalized patients. This quality improvement project utilizes a catheter maintenance bundle with seven elements with the aim of reducing CAUTI rates. The project takes place in a 20-bed neurological intensive care unit (ICU) in a larger tertiary care medical center. Prior …

A Behavioral Weight Loss Program For Low-Income Adults With Obesity And Hiv, Sophai Thach

Dissertations

Problem: Obesity, having a body mass index (BMI) of 30 kg/m² or greater, increases the risk for cardiovascular disease. For people living with HIV (PLWH), this increases their risk for myocardial infarctions by 50% and causes this life-threatening event to occur at a younger age compared to those who are not diagnosed with HIV.

Methods: With obesity disproportionately affecting people with low income, this study aims to evaluate the effects of a 12-week behavioral weight loss program that utilizes journaling as a self-monitoring tool, weekly educational classes, and individualized goal-setting on PLWH with obesity who live in …

Implementation Of The Integrated Palliative Outcome Scale (Ipos) Into Palliative Care Practice, Lisa A. Pezold

Dissertations

Abstract

Problem: The Visiting Nurse Association of Greater St. Louis (VNA) has a grant-funded, palliative care program called Advanced Illness Management (AIM). The Integrated Palliative Outcome Scale (IPOS) is a tool for providers to identify symptoms. The VNA implemented the IPOS in 2017. A previous quality improvement project revealed that IPOS symptoms were addressed less than 95% of the time leaving patients to suffer from burdensome symptoms, thereby reducing their quality of life.

Methods: Providers were educated on the importance of addressing all symptoms with pharmacologic or nonpharmacologic interventions and the impact the interventions have on the AIM program, grant …

Improving Maternal Outcomes Through Labetalol Algorithm Utilization For Hypertensive Disorders Of Pregnancy, Hailee B. Taylor

Dissertations

Hypertensive disorders of pregnancy can have negative effects on both mothers and neonates and are a major contributor to the increasing morbidity and mortality affecting women pregnant women in the United States. Treatment algorithms are available for treatment of hypertensive disorders of pregnancy when treatment criteria are met. With proper use of these algorithms, healthcare personnel can decrease the mortality and morbidity rates, which will increase patient safety and decrease healthcare spending. This research project focused on implementing The American College of Obstetricians and Gynecologists’ (ACOG) Labetalol treatment algorithm to treat patients diagnosed with severe preeclampsia. Prior to implementation, data …

Dysphagia Screening To Prevent Hospital-Acquired Pneumonia Rates, Namneet Sekhon

Dissertations

Problem Pneumonia is a leading cause of death worldwide and affects all ages. Pneumonia may be acquired by aspiration and a bedside nursing dysphagia screen may reduce hospital acquired pneumonia (HAP) rates for stroke patients. The aim of this study was to evaluate use of the dysphagia screen for all patients receiving a computed tomography (CT) scan of the head in the emergency department (ED).

Method An observational, descriptive design for all patients who received a CT of the head in the ED and admitted over a 60-day period. The rate of dysphagia screening with the DePaul Hospital Swallow Screen …