Medicine and Health Sciences Commons^™

Postpartum Depression: Educating The Provider And Staff About The Importance Of Screening, Referrals, Follow-Up And Adherence To The Maternal Mental Health Safety Bundle Toolkit, Natalie Regis

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Background: Postpartum depression (PPD) affects approximately 10%-20% of women after childbirth. PPD is a disabling condition that can have serious health implications on mothers and their infants. Experts estimated that only 50% of women with PPD are diagnosed. Lack of education about screening practices can cause the disorder to go undiagnosed and untreated.

Purpose: The purposes of this quality improvement (QI) project were 1). To increase the provider and staff knowledge about the importance of screening with the implementation of a standardized screening tool 2). To increase PPD screening rates to 100% 3). To increase appropriate referrals to mental …

Identification Of Victims Of Human Trafficking: Leading Change Through A Global Pandemic, Connie Clemmons-Brown

Doctor of Nursing Practice (DNP) Projects

Human trafficking is a multi-billion-dollar global industry, generating $150 billion annually (International Labour Organization [ILO], 2014), and driven by the exploitation of victims of all ages, primarily for forced labor or commercial sex. Victims endure frequent and prolonged abuse, suffering illnesses, and injuries. When accessing the health care system, they often go unrecognized by health care providers and nurses. Recognition requires training to raise awareness and the right tools to capture the information necessary to identify victims and address opportunities to improve their safety, care, and support. The aim of this Doctor of Nursing Practice (DNP) evidence-based change project was …

Pre-Conception Screening Tool, Nnenna Abaeze

Doctor of Nursing Practice (DNP) Projects

Problem: Sexually active women between the ages of 14 and 44 are at risk of pregnancy. This risk puts these women at high rate of unintended pregnancies.

Purpose: Currently, there is a nationwide initiative, Healthy People 2030, to reduce the rate of unintended pregnancies. Pre-conception screening is a method of mitigating this concern. Women typically receive pre-conception screening from an obstetrician, whom they visit during their annual well woman visit. The primary care setting is unique because women typically visit a primary care provider more frequently than their obstetricians. Every visit to a primary care provider is an …

Early Screening Of Postpartum Depression, Mary Ramirez

MSN Capstone Projects

Postpartum depression (PPD) is the most common pregnancy-related complication affecting over half-million mothers each year in the United States and only 50% of these women seek treatment or even receive a mental health evaluation (American College of Obstetrics and Gynecology, 2015; Horowitz & Goodman, 2004). Failure to detect or diagnose PPD can have serious consequences for both mom and baby. Nurses play a key role in discharge teaching and education, which puts them in the perfect position to ensure that adequate referrals are coordinated and to stress the importance of follow-up care to new mothers (Logsdon et al., 2018). Current …

A Quality Improvement Project To Facilitate A Human Trafficking Screening Protocol At A Maternal Resource Center, Jessica Mcdow

Doctor of Nursing Practice

Human trafficking is a global, criminal industry that negatively impacts the health of victims. Most U.S. victims of human trafficking are young females. Many female sex trafficking victims will seek health care services for unplanned pregnancies and sexually transmitted infections. Healthcare professionals fail to identify human trafficking victims due to lack of standardized screening. The aim of the project was to initiate a sustainable, standardized human trafficking screening protocol at a Maternal Resource Center in order to improve human trafficking identification.

This 10-week quality improvement project provided the staff and volunteers at a Maternal Resource Center with the necessary tools …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Recognizing Delirium In The Picu: An Evidence-Based Practice Improvement Project, Abigail Begovich

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Introduction: Pediatric delirium is underrecognized in the pediatric population and can lead to increased length of stay, hospital costs, and post-traumatic stress disorder (PTSD). Using a standardized screening tool to assess for delirium is an easy way for bedside nurses to evaluate patients and intervene as necessary. This quality improvement project aimed to implement the Cornell Assessment of Pediatric Delirium (CAPD) and complete a delirium screening on applicable patients once a shift > 85% over four months.

Methods: Between January 2020 to May 2020, bedside nurses completed a delirium screening assessment on applicable patients, first on paper and then …

Promoting Recognition And Rescue: Human Trafficking Screening, Erin E. Pittman

MSN Capstone Projects

The exploitation of human beings is a serious public health concern (Centers for Disease Control [CDC] 2018). The United States Department of Justice (2018) defines human trafficking as an act of coercing a person’s labor services or commercial sex acts. Family Nurse Practitioners play a significant role in the identification of victims, especially those practicing in emergency departments. A majority of healthcare providers have yet to establish a standardized screening tool and there is little evidence regarding the impact these screening tools have in recognizing victims of human trafficking (Emergency Nurses Association, 2018). This alarming information brings about the clinical …

Start Stop-Bang, Valerie D. Reeve

MSN Capstone Projects

Currently standard of care in the perioperative unit is not conducive when caring for patients with obstructive sleep apnea (OSA). OSA is highly prevalent and often undiagnosed. Screening patients with a STOP-Bang questionnaire is quick, effective, and cost efficient. OSA is linked to poor postoperative outcomes. Patients at high risk for OSA often encounter complications such as: additional airway management, respiratory complications, cardiovascular complications, and increased length of stay. Screening creates awareness and identification of patients at risk for postoperative complications.

Barrett's Esophagus, Laura Hickey

Nursing Student Class Projects (Formerly MSN)

The incidence of esophageal cancer, a deadly cancer, is rising and the only known precursor is Barrett’s esophagus. Barrett’s esophagus is a condition in which mucosa undergo progressive multi-step cellular changes. Currently, the exact pathogenesis is uncertain, but likely occurs from chronic reflux of acid and bile in the distal esophagus. Understanding the limited pathology of Barrett’s esophagus guides screening, surveillance, diagnosis and treatment. The current focus, though guidelines vary, recommends screening those at highest risk of developing Barrett’s: Caucasian males, over the age of 50, with central obesity, gastroesophageal reflux disease, a history of smoking and a familial history …

The Intersection Between Sexual Assault And Mental Illness: Psychiatric Nurse’S Role, Shylettera Davis, Leslie Miles, Julie Valentine, Linda Mabey

Student Works

The Intersection between Sexual Assault and Mental Illness: Psychiatric Nurse’s Role

Shylettera Davis

College of Nursing, BYU

Master of Science

Background: Mental illness (MI) affects one in five Americans. Individuals with severe MI are frequently victims of crime, which includes sexual assault (SA). It is well established that individuals with severe MI are more vulnerable for SA victimization. What is not recognized is if this vulnerability for SA extends to other less serious types of MI.

Aim: To identify and synthesize findings from the literature for any connections between having a MI and increased vulnerability for SA victimization, specific mental …

Nurse Practitioner Student Confidence And Competence In Common Women's Health Diagnostic Procedures, Jessica Cowan

Dissertations

Problem: In areas with limited health resources, such as Guatemala, cost-effective and reliable methods for sexually transmitted infection and cervical cancer screenings are needed. The purpose of this Quality Improvement (QI) project was to develop standardized training in Vaginal Wet Mount (VWM) preparation and cervical cancer screening using Visual Inspection with Acetic Acid (VIA) for Nurse Practitioner students who traveled to Guatemala for a week-long global immersion experience.

Methods: This was a QI project with a prospective descriptive design utilizing a purposive sample of 10 University of Missouri-St. Louis Nurse Practitioner students who traveled to Guatemala on medical mission trip …

The Impact Of Education And Resources On Postpartum Depression Screening And Referral In Pediatric Primary Care., Shannon Williams

Doctor of Nursing Practice Papers

Background: Postpartum depression (PPD) is recognized as one of the most common complications following childbirth. Despite evidence-based recommendations to screen for postpartum depression in pediatric primary care, screening rates during well-child visits remain at less than 50%. Pediatric providers have consistently identified barriers to screening mothers for PPD. Methods: A multifaceted educational intervention was implemented that focused on screening for PPD during well-child visits and oriented providers to resources and a local referral process for mothers who screened positive. A pretest-posttest design was used to measure provider knowledge, confidence, and awareness in screening, utilizing available resources and a local referral …

Improving Latent Tuberculosis Infection (Ltbi) Screening And Treatment In A School-Based Setting, Andrea Bell

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: San Diego County’s tuberculosis (TB) incidence rate is nearly double than the national rate. In 2019, there have been 5 cases of active TB in the county’s public high schools, which have demonstrated the need for prevention interventions in this setting.

Objectives: This evidence-based project is aimed to increase awareness, screening and treatment of latent TB infection (LTBI) in the school setting.

Methods: A TB risk assessment form and consent was sent in the registration packets. A one-time TB educational presentation was given to high school freshman students with a pretest and posttest. For students at-risk, a confidential …

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine …

Improving Outcomes For Patients With Osa Receiving Anesthesia, Natalie Bram

Doctor of Nursing Practice Projects

Obstructive Sleep Apnea (OSA) is a dangerous sleep disorder that is rising in prevalence, afflicting 29.4 million Americans or 12% of the U.S. population (AASM, 2017). Although OSA has the ability to negatively impact postoperative outcomes, numerous patients remain undiagnosed, unidentified, and improperly treated for OSA at the time of surgery (Baugh, 2013; Opperer et al., 2016). Evidence supports the STOP-BANG questionnaire as an effective, easy to use, and highly sensitive tool for screening patients for OSA (Chiu et al., 2016; Dolezal et al., 2011; Lakdawala, Dickey, & Alrawashdeh, 2018).

A 137-bed hospital had no standing preoperative protocol for the …

Developing The Pedis Pediatric Obstructive Sleep Apnea Screening Tool, Steven Sumpter

Doctor of Nursing Practice Projects

Obstructive sleep apnea (OSA) is the most common type of apnea in the pediatric population. Its prevalence is 0.7%-3.0% (Garcia et al., 2016). The dangers of OSA are multiplied in conjunction with anesthesia because anesthesia resembles a state of sleeping, relaxing the airway, and requiring more intense airway monitoring. Childhood OSA includes increased risk for developing neurocognitive impairment, behavioral problems, failure to thrive, hypertension, cardiac dysfunction, systemic inflammation, and increased healthcare costs (Kothare et al., 2015). A perioperative pediatric OSA screening tool is necessary to reduce airway risks. The PEDIS screening tool is a brief, efficient, and evidence-based tool capable …

An Osteoporosis Risk Assessment Workshop For Advanced Practice Nurses, Linda Gay

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

Osteoporosis is noted as one of the foremost causes of disability and morbidity worldwide (Rapp et al., 2016). An osteoporotic fracture can result in significant debility, resulting in significant financial burdens. Screening guidelines for osteoporosis are in place, but confounding variables often lead to missed screening and treatment opportunities. Xu, Lombardi, Jiao, and Banfi (2016) state that bone health is essential for maintaining quality of life and overall health and that one out of two Caucasian women will suffer an osteoporotic-related fracture in her lifetime. Current research supports identifying those at risk, screening, and potentially implementing pharmacological treatment regimens to …

The Effect Of The Screening, Brief Intervention, Referral To Treatment (Sbirt) Model On Adult Depression In An Outpatient Setting, Genevieve E. Sweeney

Doctoral Projects

Depression is one of the most common chronic conditions in the world. Despite this, depression continues to be under-screened, inaccurately assessed and diagnosed, and poorly treated in outpatient settings. Many providers solely rely on clinical judgement instead of a screening tool or evidence-based toolkit when a patient presents with depression symptoms, resulting in underdiagnosis and inappropriate treatment. Utilization of resources can help a provider appropriately screen, diagnose and treat an individual with depression. Screening, Brief Intervention, Referral to Treatment (SBIRT) is an evidence-based model intended to improve these measures. Studies from the literature support the efficacy of the SBIRT model …

Implementation Of Standardized Hereditary Breast And Ovarian Cancer (Hboc) Risk Assessment And Genetic Referral, Melissa M. Hessock

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Objective: To increase identification and genetic referral rates for women at risk of Hereditary Breast and Ovarian Cancer (HBOC).

Design: Evidence-based practice improvement initiative

Setting/Local Problem: Private suburban OB/GYN practice in Tennessee with no standardized process for HBOC risk assessment or genetic referral.

Participants: Women age 18 or older, presenting for routine well-woman visits.

Intervention/Measurements: Using PDSA (plan-do-study-act) cycles, a familial risk assessment tool was selected, and a clinical decision-making algorithm for risk assessment and genetic referral was designed and implemented for use in well-woman encounters. Pre-implementation and post-implementation risk identification and referral rates were …

Improving Behavioral Health And Social Determinants Of Health Screening In Primary Care, Caitlin Gerity Ba, Rn, Dnpc

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

Purpose: Detection and intervention of depression, substance use disorder, and social determinants of health (SDOH) in primary care improves quality of life, prevents complications, reduces health care costs and inequities, and leads to health promotion. This project aimed to increase behavioral health and SDOH screening rates in primary care through implementation of a screening process utilizing validated patient questionnaires.

Methods: A pre-intervention assessment was conducted with Providers A and B. A process was then developed for screening patients at annual exam visits, utilizing the Patient Health Questionnaire (PHQ)-2, the Single Alcohol and Substance Abuse Screening Questions, and a SDOH Questionnaire. …

Screening For Palliative Care Services In An Assisted Living Facility, Maria Delia Crosby

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

Background: Palliative care services remain under-utilized, even as evidence suggests that early palliative care leads to positive health outcomes, reduced ED visits, and substantial cost savings. Barriers include a lack of knowledge of palliative care services in the community, and under-utilization of validated assessment tools, including a symptom checklist. Aims of this project: 1. To determine whether the integration of validated community-based palliative care screening tool in an assisted living setting will identify older adults with unmet palliative care needs. 2. To determine if tool implementation could lead to a referral for palliative care consultation.

Methods: A screening tool developed …

Using Social Media As A Platform For Increasing Knowledge Of Lung Cancer Screening In High-Risk Patients, Aimee Strong, Michelle Renaud

Nursing Faculty Publications

Background: Uptake in lung cancer screening for high-risk patients remains low. Eligible patients may not know that this preventive service is available and covered by insurance.

Objectives: The objective of this study was to explore using social media to educate patients about lung cancer screening and assess motivation to discuss lung cancer screening with health-care providers after viewing the educational program. Methods: Subjects ages 55 to 77 who were current smokers or former smokers who quit in the past 15 years with a more than 30-pack-year smoking history were recruited via a Facebook advertisement. Subjects completed a demographic survey and …

Adolescent Substance Abuse Screening, Wesley W. Lynch

Walden Dissertations and Doctoral Studies

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse …

Improving Intimate Partner Violence Screening Practices Among Postpartum Nurses, Robin Mills-Humphreys

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of the Literature: Intimate partner violence (IPV) during pregnancy is a global public health issue that has negative outcomes on both an individual and a societal level. Health care providers play a pivotal role in providing services to women experiencing violence during pregnancy. Regardless of the setting, barriers to IPV screening exist among healthcare providers. Review of the literature examined the existing IPV screening practices and screening barriers among healthcare providers to better understand the relationship between barriers and frequency of screening for IPV. Purpose: The purpose of this DNP project was to enhance …

Evaluating Colorectal Cancer Screening Rates In An Urban Primary Care Practice, Kristen Makowski

DNP Projects

Colorectal cancer accounts for 8% of all cancer deaths and can be prevented through timely removal of colon polyps. Despite recommendations for routine screening, approximately 31.2% of patients go unscreened for this disease (Centers for Disease Control and Prevention, 2018). The purpose of this project was to determine screening rates and documentation mechanisms for colorectal cancer in an urban primary care practice, to determine how many patients completed the screening, and to present findings to the practice providers along with exploring ways to increase screenings. An additional purpose of this project was to determine and identify patient demographics which can …

Adolescent Substance Abuse Screening, Wesley W. Lynch

Walden Dissertations and Doctoral Studies

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin's 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse …

Childhood Anxiety, Cognitive Behavioral Therapy And/Or Pharmacological Treatment, Jennifer S. Mccarthy

All Graduate Theses, Dissertations, and Other Capstone Projects

Objective: Evaluate best practice in managing anxiety in the pediatric population, including both school age children and adolescents. This literature review compared pharmacological treatment and cognitive behavioral therapy (CBT)’s effectiveness on the management of anxiety within the pediatric population.

Background: Up to 25% of children in the United States are affected by a mental health disorder, anxiety being the most prevalent. Childhood anxiety can have a distressing impact on social, family, and academic functioning. If persisting into adulthood it increases the risk of developing other co-occurring mental health conditions, substance abuse issues, and contributes to impaired employment retention and socioeconomic …

Improving Assessment, Documentation, And Ordering Of Diabetic Retinopathy Screenings In A Primary Care Clinic, Lauren N. Motto

DNP Projects

Abstract

BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS).

PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or …