Medicine and Health Sciences Commons^™

Reducing Antipyretic Use For Low-Grade Fevers In Otherwise Healthy Children, Tricia A. Templet

Doctor of Nursing Practice Final Manuscripts

Fever phobia is persistent in the pediatric population, as fever is a common complaint for advice calls, sick visits, and urgent care/emergency department utilization. Fever phobia among parents and healthcare providers is evidenced by the quest to return a child to normothermia. Fevers under 38.5ºC (101.3ºF) are considered benign in healthy children, usually requiring no pharmaceutical intervention. Research consistently demonstrates pediatric nurses inappropriately medicate patients for low-grade fevers. The purpose of this evidence-based practice project was to identify knowledge of the benefits and myths of fever in otherwise healthy children and to decrease the use of antipyretics for low-grade fevers …

Improving Asthma Symptoms Using Asthma Action Plans, Ryan Daniel Thebo, Michael Terry

Doctor of Nursing Practice Final Manuscripts

Asthma is a chronic disorder characterized by airflow obstruction, causing chest tightness, wheezing, coughing, and shortness of breath. In California, 7.9% of patients have an asthma diagnosis. The 2007 NHLBI Expert Panel Report 3 recommended using asthma action plans in asthma management (NHLBI, 2007). Patients with asthma were taught to use an AAP to improve asthma control. Overall, 80% of patients improved by at least one EPR3 asthma control category.

Telephone Calls To Reduce 30-Day Readmissions For Older Adults With Heart Failure, Juanette G. Clark

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidenced based practice project was to evaluate the effectiveness of discharge follow-up calls for heart failure (HF) patients recently discharged from a private hospital.

Background: HF is the number one discharge diagnosis among patients 65 years and older. It affects 5.8 million people in the United States. HF admissions total (1) million annually, however, 24% of these patients are readmitted within 30 days of discharge. Re-hospitalizations are associated with high mortality rates and expenditures approximated at $13,000 per patient contributing to the overall annual expenditure of $33.7 billion. In 2012, the Centers for Medicare …

Supporting Self-Management In Veterans With Chronic Pain: A Policy Perspective, Erin W. Lind

Doctor of Nursing Practice Final Manuscripts

The purpose of the project was to do an evidence-based review of the effectiveness of promoting self-care on pain levels and quality of life among veterans with chronic pain at a national level. A review of current chronic pain management policies for veterans in southern California was also conducted. Active self-management initiatives permit more diverse, patient-centered treatment, promote self-management, and are relatively safe and cost-effective. Our results have confirmed that chronic pain is on the forefront of priorities for the Veterans Health Administration (VHA) due to an increasing rate of both chronic pain and opioid overdoses.

Wecan Implementation For Parents Of At-Risk Hispanic Adolescents In Middle School, Shannon Leigh Devita

Doctor of Nursing Practice Final Manuscripts

Abstract

CDC-reported childhood obesity rates have tripled in the past three years. Among children in grades five, seven and nine, 30% are overweight or obese, with Hispanic students more likely to be overweight than White students. This evidence-based project examined the effectiveness of NHLBI’s WeCan! for at-risk middle-school-age Hispanic children and parents. The program was implemented at school in two weekly sessions, and its effectiveness was evaluated using the WeCan! survey. The program resulted in improved knowledge, behaviors, and attitudes related energy balance, portion size, healthy foods, physical activity, and screen time and may be useful in other school settings.

Transition After Breast Cancer Treatment: Implementing Survivorship Care Plans, Susan Hope Klein

Doctor of Nursing Practice Final Manuscripts

The success of cancer treatments have resulted in a rapid growth of survivors, providing the impetus for the oncology community to examine models of care supporting smooth transition from active treatment to survivorship care. While initially a recommendation of the Institute of Medicine, treatment summaries and survivorship care plans are now an accreditation requirement for many organizations. This article describes the implementation of an evidence based practice project designed to meet these standards while improving the knowledge and satisfaction of a population of breast cancer patients at a community-based oncology practice.

Emergency Protocol Program For High School Athletes, Casandra B. Moyer

Doctor of Nursing Practice Final Manuscripts

This evidence-based project (EBP) involved development and implementation of an emergency protocol (EP) education program for high school athletes and coaches at a southern California high school. A Doctor of Nursing Practice student, collaborating with health care and athletic personnel, conducted an assessment of the high school’s EPs for management of asthma, anaphylaxis, diabetes, and heat illness. Then, an EP and educational program were created; coaches and athletes were educated on the protocol during a coaches’ meeting and practice times, respectively. All participants completed pre- and post-tests, and mean knowledge scores were compared. The overall knowledge score increased by 10% …

Improving Utilization Of 2012 Asccp Guidelines In A Family Practice Setting, Michelle M. Mccormick, Mary Barger

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project is to decrease unnecessary colposcopy referrals using provider education and user friendly tools. This is accomplished by increasing utilization of the 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines at a Military Treatment Facility Family Practice Clinic. Despite clear cervical cancer screening guidelines, nationwide, women are continuing to have unnecessary Pap testing regardless of HPV status. Over screening can result in an increase in false positive results, leading to rising healthcare costs, additional office visits, and stress to the patient from procedures that yield little useful information or decrease in morbidity. Although …

Improving Hpv Vaccinations In Military Women, Sarah Beth Wedel

Doctor of Nursing Practice Final Manuscripts

Project Purpose: The purpose of the project was to implement Human Papillomavirus (HPV) patient education during every well woman exam (WWE) to improve patient knowledge and HPV vaccination rates in military women aged 18-26 years.

Background: The Human Papillomavirus (HPV) has been identified as the biggest risk factor for cervical cancer and, despite the availability of a vaccine; HPV continues to be the most common STI in the U. S. (American Cancer Society, 2013). Approximately 79 million Americans are currently infected with HPV, and 14 million individuals will become infected annually, leading to more than 10,000 cases of cervical cancer …

Instituting Patient-Self Test Meters In Adults On Warfarin In A Cardiology Practice, Melvyn Grace Manzano Rabanal

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the oral anticoagulant that is most commonly used to control and prevent thromboembolic disorders. It requires meticulous testing and dosing adjustments to attain therapeutic international normalized ratio (INR) levels. Patient self-testing (PST) is associated with a reduced risk of all-cause mortality and lower rates of thromboembolism and bleeding. PST meters offers convenience and promotes self-initiative of care.

Purpose: The purpose of the project is to evaluate the effectiveness of INR PST in adult patients diagnosed with atrial fibrillation, deep vein thrombosis, and mechanical heart valve on warfarin therapy in a Cardiology practice compared to traditional …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Heart Failure Patient Self-Care: An Evidence-Based Outpatient Management Program, Christine Marie Ensign, Shelley Hawkins, Barry Greenberg

Doctor of Nursing Practice Final Manuscripts

Background: According to the American Heart Association, there are over 5 million people in the United States with heart failure (HF) and projections suggest the prevalence of HF will increase by 46% through 2030. HF is the most common cause of hospital admissions in the United States for patients age 65 years or older and despite improvement outcomes, national readmission rates remain high at 23%. Current guidelines recommend health professionals provide comprehensive HF education and counseling that is not only focused on knowledge, but also on skills of management and self-care behaviors. In order to achieve quality patient-centered care, …

Evaluating Physical Therapy For Adolescent Patients With Low Back Pain, Kelly Denise Gonzales

Doctor of Nursing Practice Final Manuscripts

Background: Low back pain is a condition affecting many people worldwide. The age of onset is variable, affecting all patient populations from childhood throughout the lifespan. Aims/Purpose: The efficacy of physical therapy for adolescent patients with back pain seen in a pediatric orthopedic clinic was evaluated through comparison of pre and post-intervention pain scores. Patient compliance with physical therapy was monitored and evaluated against outcomes.

Design: A six-month retrospective chart review of adolescent patients with a diagnosis of low back pain. Patients with a diagnosis of low back pain were referred for physical therapy and provided with a home exercise …

Transitional Care Of Adult Patients With Diabetes Following Hospitalizations, Eric Tobin

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project was to incorporate a diabetes transitional care program using group visits to improve self-care management behaviors and glycemic control in diabetic patients at a southern California hospital.

Background: Diabetes is a challenging healthcare problem associated with significant mortality and morbidity issues. In 2012, 29.1 million people, or 9.3% of the U.S. population, were diagnosed with diabetes, and 28.9 million of those patients were 20 years of age and older. Today, diabetes is of epidemic proportion worldwide, and a projection of 5.4% of the adult population will have diabetes by 2025. The …

Clinical Effectiveness Of Inr Patient Self-Testing: Adults On Warfarin Therapy In Private Practice, Anisa Munshi

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the most commonly prescribed oral anticoagulant for the prevention and treatment of venous thromboembolism. Due to its narrow therapeutic index, warfarin requires close monitoring of the international normalized ratio (INR) to ensure proper anticoagulation control and safety. INRs outside of this range are strongly associated with an increased risk of major bleeding, thromboembolic events, and death. Patient self-testing (PST) using a point-of-care device allows patients to monitor INR results at home. Evidence shows that PST improves the clinical outcomes of warfarin therapy compared to usual care, which includes laboratory INR monitoring. Purpose: To compare the clinical effectiveness …