Asthma And Peak Flow Assessments Based On Nhlbi Asthma Guidelines, Julia Gliceria Almario Regalado

Doctor of Nursing Practice (DNP) Projects

Background: Asthma exacerbations are consequences of poor asthma control. Asthma guidelines-grounded interventions can improve adherence to asthma guidelines and assessments in primary care settings. The goals of asthma management are to optimize asthma control, minimize the risk of asthma exacerbations, and minimize the adverse effects of asthma medications.

Local Problem: A primary care practice in Northern California had frequent office visits for acute asthma symptoms. Ongoing asthma control monitoring is a key performance indicator of high-quality asthma care.

Methods: The quality improvement evidence-based observational project examined the effectiveness of interventions. The pre-and post-survey assessments collected clinician knowledge and adherence, and …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Improving Culturally Competent Lgbtq+ Care Among Primary Care Providers, Christopher Diaz

Doctor of Nursing Practice (DNP) Projects

Purpose: Although general efforts have been made to identify, address, and improve the standing of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, many of these individuals continue to experience stigmatization and discrimination daily. These experiences influence the health of these individuals, which leads to several health disparities including an increased risk for numerous physical and mental health conditions.

Methods: Using nationally developed guidelines, the author of this project developed two didactic-style educational presentations for primary care providers to improve cultural competency for LGBTQ+ individuals. Eight providers completed both presentations, which explored the attitudes, knowledge, and beliefs/practice intentions of …

Shared Decision Making For Primary Care Patients With Medical Complexities, Cori B. Fappiano

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Implementing Intimate Partner Violence Screening In The Primary Care Setting, Deirdre F. Howard

Doctor of Nursing Practice (DNP) Projects

Background. Intimate partner violence is a highly prevalent problem in the United States and leads to serious negative physical and psychological health outcomes, including death. There are screening tools that can detect IPV, yet screening rates in healthcare settings remain low, due to a variety of barriers, including lack of time, confidence, screening policies, and resources. Purpose. The purpose of this DNP project was to increase IPV screening rates within a primary care clinic.Methods. To accomplish the purpose of the project, an education intervention on IPV and available resources was provided to clinicians and staff. This was followed by …

Substance Use Disorder: Primary Care Screening, Shari P. Shaltout

Doctor of Nursing Practice (DNP) Projects

Substance use disorder is a significant problem in the United States causing considerable distress and cost to the healthcare system as well as familial, community, and societal resources. Based on evidence-based research, a statement by the United States Preventive Services Task Force in 2015, recommends substance use disorder screening for adults in the primary care setting. A review of the literature concerning screening tools for substance use disorder resulted in twelve studies being included. The purpose of this project is to determine if the more comprehensive substance use disorder screening tool, ASSIST, identifies more at risk patients than the current …

Technology-Based Advance Care Planning Education For Primary Care Patients, Taryn Achong

Doctor of Nursing Practice (DNP) Projects

Background: Advance Care Planning (ACP) encompasses a multidisciplinary, collaborative process that allows patients to understand their health and make informed decisions in their treatment plans. Considering the COVID-19 pandemic and recent research, ACP is considered imperative for all patients. Evidence-based approaches include supplemental group sessions, case manager interventions, and provision of at-home resources. Within the pandemic, there has also been a rapid shift to telemedicine, restricting most ACP efforts. Therefore, the utilization of technology-based ACP resources and telemedicine is highly supported.

Purpose: This DNP project serves to assist an internal medicine practice located in Hawaii’s metropolitan area. Although the …

Implementation Of An Evidence-Based Screening Tool For Children For Detection Of Developmental, Behavioral And Family Issues, Lyndsay Goss

Doctor of Nursing Practice (DNP) Projects

Background: Children are a vulnerable population who are at risk for a variety of developmental, behavioral and family concerns. Early intervention leads to improved outcomes. By implementing the comprehensive evidence-based screening tool the Survey of Well-being for Young Children (SWYC), within a Federally Qualified Health Center (FQHC), outcomes for these children may be improved through early intervention.

Methods: The SWYC survey was provided to parents and guardians of children ages zero to five years at one pilot site at a FQHC in New England during well child visits (WCV) over a 6-week period. Implementation success was measured through review …

Improving The Frequency And Efficacy Of Advance Care Planning In Primary Care, Katherine Farrell

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a process to support patients in understanding and expressing their future medical wishes. Despite evidence supporting the benefits of ACP there remain a number of barriers limiting uptake of this important practice. Absence of advance care planning places patients at risk of receiving care misaligned with their values, goals, and preferences as well as increased patient and family distress at end-of-life. Purpose: This quality improvement (QI) project addressed provider knowledge, and patient awareness and level of engagement in the advance care planning process in an effort to increase the frequency and efficacy of ACP …

Identification Of Post-Intensive Care Syndrome (Pics) In Primary Care, Danielle L. Riggi

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Post-intensive care syndrome (PICS) occurs in approximately 50% of ICU survivors and increases risk of mortality and hospital readmission while decreasing quality of life. There were no national guidelines for diagnosis or treatment of PICS at the time of the completion of this project.

Purpose: The purpose of this project was to increase identification of PICS in the primary care setting by providers. This was accomplished by implementing an educational toolkit and algorithm to better identify patients with PICS and to evaluate the incidence of PICS.

Methods: An educational presentation and a survey were presented to the providers …

Implementation Of Trauma Informed Care In A Primary Care Setting Using The Adverse Childhood Experience As A Screening Tool, Adedoyin Adepoju

Doctor of Nursing Practice (DNP) Projects

Background: The prevalence of trauma is widely unacknowledged in the primary care setting. Unfortunately, the injury that individuals sustained as children may continue to adversely affect their health as adults in various ways, including having risky health behaviors, early death, chronic health conditions, and low life potential. Prevention of trauma is crucial and can is achieved with consistent public health education. There are available treatments for childhood trauma, and the inclusion of primary care for screening is vital for quality care.

Purpose: The Adverse Childhood Experience (ACEs) is a screening tool that can be utilized to survey adult patients …

Implementing Foot Care Program In A Rural Clinic, Maliheh Bakhshi

Doctor of Nursing Practice (DNP) Projects

Abstract

The prevalence of type 2 diabetes mellitus and its complications have increased in the United States (U.S.) in recent years. Patients with diabetes have a higher risk of foot ulcers due to diabetic peripheral arterial disease accelerated by the direct damage to the nerve and blood vessels in lower extremities by high blood sugar. Foot amputations, and frequent hospital admissions due to these and other diabetes complications are also increasing. Healthcare providers’ have a unique opportunity to prevent these complications and hospital admissions, and to promote patient wellness and physical well-being through the provision of timely education and direct …

Increasing Staff Knowledge And Screening Practices For Adverse Childhood Experiences In Primary Care, Angela Mcgraw

Doctor of Nursing Practice (DNP) Projects

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened …

Improving Wound Care Using The Time Framework, Pavel Kulikov

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and purpose:Although wound care guidelines are available for primary care providers, barriers to assessment and treatment remain. This paper examines current evidence, guidelines, and discusses the need for improved training, education, and a simplified approach to wound management in primary care. The goal of the project was to increase the provider’s comfort level in assessing and initiating wound care treatment in the clinical setting. Methods:An evidence-based wound treatment framework, identified as the TIME (tissue, infection, moisture, epithelial) framework, was selected for the project. The framework was tailored by subject matter experts to provide a distinctive approach …

Establishing A Nurse Practitioner Residency Program In A Rural Federally Qualified Health Center: A Feasibility Analysis And Pilot Study, Seson Kahn Dnp, Fnp, Alexa Curtis Phd, Fnp-Bc, Jodie Sandhu Dnp, Fnp-C

Doctor of Nursing Practice (DNP) Projects

Abstract

Rural communities are disproportionately underserved and have been identified as a priority population to improve health outcomes and access to care (Agency for Healthcare Research and Quality [AHRQ], 2015). National organizations have recognized a deficit in primary care providers, recommended nurse practitioners (NPs) as a solution, and supported NP residency programs as a means to prepare and recruit qualified practitioners into communities (Institute of Medicine [IOM], 2010; The Patient Protection and Affordable Care Act [PPACA], 2010). However, there are only three primary care NP residency programs in rural California (National Nurse Practitioner Residency and Fellowship Training Consortium [NNPRFTC], 2015). …

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 …

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 …

Increasing Access To Primary Care Using Np’S: The Framework For An Academic Based Nurse-Managed Center In California, Prabjot (Jodie) Sandhu

Doctor of Nursing Practice (DNP) Projects

The dynamics of health care delivery and the role of health care providers is a changing canvas in the United States. The implementation of the Affordable Care Act (ACA), sets a goal to increase access to health care. The systems that support the ACA are constantly under scrutiny as failing to provide key answers to provider shortage and health care access issues. Nurse Practitioners (NPs) who are recognized by the ACA as a comprehensive part of this revolution are in a unique place to find opportunities to promote increased access to health and primary care services. While NPs in California …

Improving The Detection And Management Of Hypertension In Adults In The Primary Care Setting: A Quality Improvement Project Based On The Chronic Care Model Using Blood Pressure Monitoring And Clinical Practice Guidelines, Michelle A. Cutler

Doctor of Nursing Practice (DNP) Projects

Background: Hypertension (HTN) is a common, costly, and deadly disease that is often under recognized, under diagnosed, and undertreated in the primary care setting. Despite the presence of effective treatment strategies, uncontrolled HTN remains a persistent problem.

Purpose: The aim of this Doctor of Nursing Practice (DNP) project was to improve the quality of HTN care delivered to adults in a primary care practice. Goals were targeted to decrease providers’ clinical inertia by improving their ability to make better diagnosis and treatment decisions after reviewing more comprehensive objective data.

Methods: Using the Chronic Care Model in an independent primary care …

Management Of Adolescent Depression In The Primary Care Setting: An Educational Program For Providers, Kelly Clow

Doctor of Nursing Practice (DNP) Projects

Background: The prevalence of adolescent depression is estimated at 15-20% in the general population and often under-treated. The primary care provider is in a prime position to identify and treat depression in this age group. However, many providers feel uncomfortable with treating and managing depression in adolescents, due to a lack of education or experience. Purpose: The focus of this quality improvement project was to educate primary care providers on the current recommendations for the management of adolescent depression and provide an education sheet for both the medical and non-medical treatment of adolescent depression. An educational intervention was presented to …

Implementation Barriers Of The Phq-9 In Primary Care: A Quality Improvement Project, Angela P. Miller

Doctor of Nursing Practice (DNP) Projects

Purpose: The purpose of this research translation project was to mitigate the consequences of under-recognition, and under-treatment of depression through use of an evidence-based depression-screening tool, the PHQ-9, in a primary care setting.

Methods: A plan-do-study-act model was utilized for the implementation of this initiative. An informal educational intervention about administration and interpretation of the PHQ-9 first took place at the provider level in a primary care practice. Next, a pre and post-test study design (n=12) was administered to providers, nursing, and ancillary staff. A report was shared at monthly quality meetings with representatives from each practice in the health …

Moving Beyond The Ask: Improving Tobacco Cessation Intervention Delivery In Primary Care, Joan D. Johnston

Doctor of Nursing Practice (DNP) Projects

Background: Quitting smoking at any time benefits health. Primary care visits provide the opportunity to advise current tobacco users to initiate a quit attempt, explain available quit options and arrange for adequate follow-up care. Purpose: The purposes of this DNP project were to provide a staff development educational activity and introduce a workflow modification intended to extend the effectiveness of a tobacco cessation intervention delivered during an office visit. Methods: Medical Assistant staff members responsible for patient recruitment completed a pre-test, viewed an online tobacco educational module and completed a post-test. Using convenience sampling methodology, a cohort of …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

Eat Well, Live Actively: A Primary Care Interventional Program For The Treatment Of Childhood Obesity, Julianne M. Randlemon

Doctor of Nursing Practice (DNP) Projects

Over the last thirty years, childhood obesity has become one of the presiding diseases in the pediatric population. Last year the CDC (2012) reported that 12.5 million children under the age of five were not only overweight but also obese. This growing trend has been inadequately addressed by the United States preventive healthcare system. The pandemic has continued to spread: America’s obese children have substantially contributed to the ever-growing fiscal demands of health care in the United States. Olshansky et al. (2005) suggest this will in turn translate into the first generation of American adults that will be sicker and …