Medicine and Health Sciences Commons^™

Educational Intervention For Identification Of Metabolic Syndrome (Icd-10 E88.81): Presentation Of A Toolkit For Providers And Staff In Two Primary Care Settings, Sadie Russell

Doctor of Nursing Practice (DNP) Projects

Metabolic syndrome plays a vital role in present-day primary care. The ICD-10 diagnostic coding for this set of symptoms more comprehensively identifies patients with increased risk of cardiovascular events and comorbidities. Metabolic syndrome affects one-third of adults in the US and is defined as the presence of three of the following characteristics: abdominal obesity, hypertension, elevated triglycerides, low high-density lipoprotein, and elevated fasting plasma glucose. Proper screening for metabolic syndrome can identify complex patients before conditions like hypertension or type II diabetes develop. Management of metabolic syndrome emphasizes prevention and prioritizes lifestyle modifications as first-line treatment. Despite strong evidence supporting …

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 …

Improving Hpv Vaccination Initiation And Completion Rates: A Qi Project, Princy M. Varughese

Doctor of Nursing Practice (DNP) Projects

Human papillomavirus (HPV) is a common sexually transmitted infection in the United States and is the cause of most cervical cancers in women, as well as anogenital cancers, oropharyngeal cancer, and genital warts in both men and women (Centers for Disease Control [CDC], 2014b). The HPV vaccine is recommended for preteen girls and boys to protect against HPV infections (CDC, 2011). In line with the goal of Healthy People 2020, the purpose of this evidence-based quality improvement (QI) project was to implement a text message reminder system, and calculate the completion rate of the 3-dose HPV vaccination series among adolescents …

No Place For Distress: Implementing A Simple Tool To Screen And Address Distress Symptoms In An Adult Outpatient Cancer Center, Ramona E. Chase

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The Distress Thermometer (DT) is a simple and valid tool that should become the standard of care in the outpatient cancer setting to help clinicians better identify psychosocial distress at an early stage. The purpose of the project was to implement distress screening with the distress thermometer (DT) with problem list (PL) to screen and address distress symptoms in an adult outpatient cancer center.

Method: The distress screening pivotal visit was incorporated into the patient’s care plan at on day 8 on the 3^rd cycle of the patients’ chemotherapy regimen. Patients graded their level of distress on …

Increasing Cultural Awareness And Competency In A Community Hospital In Northwest Minnesota, Gladys N. Nyabwari

Doctor of Nursing Practice (DNP) Projects

Background: Cultural competency is an essential component in the delivery of healthcare services in all sectors of health. Therefore, educating healthcare professionals on cultural competency requires understanding evidence-based studies, having the ability to translate these research findings to practice, and providing the resources to implement best practice in the work place. The process requires individuals to have cultural awareness and humility to be able to attain any given level of cultural competency. Purpose: To improve cultural awareness in a community hospital in Minnesota by implementing an on-going process that allows employees to both acquire knowledge and maintain their skills …

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 …

Acute Chest Pain Triage And Management Guideline Effects On Patient Safety And Physiological Outcomes In A Primary Care Office Setting, Michael D. Hibbs

Doctor of Nursing Practice (DNP) Projects

Background: Heart disease remains the number one killer of Americans with an estimated 599,413 deaths in 2013 attributed to this condition and its treatment has inflated to an annual cost of $190 billion. This mortality is partially attributed to ineffective outpatient triage, management, and treatment of patients with acute chest pain. Methods: The purpose of this newly proposed acute chest pain triage and management guideline was: (1) to decrease inappropriate wait times and incongruous office appointments resulting in delay of care, patients being referred to the emergency room (ER) or, direct admissions to the hospital from the primary care …

Nutrition & Physical Activity Newsletters, Dianne Dwyer

Doctor of Nursing Practice (DNP) Projects

Background: School-age children in Kettering, Ohio are at risk of morbidity from chronic disease indicated by the percentage of overweight children in the state compared to national averages. A food program has been established to provide children of low-income families free and reduced meals. Currently the food program does not include education on nutrition and physical activity as recommended by national guidelines. Purpose: The purpose of this project is to add an educational intervention for nutrition and physical activity to the current food program in order to meet the current guidelines for nutrition and physical activity. Methods: Monthly newsletters …

Pneumococcal Pneumonia In The Older Adult: Increasing Patient Education And Vaccination, Jessica E. Valletta

Doctor of Nursing Practice (DNP) Projects

Background:Pneumococcal disease is a transmitted infectious illness that results in serious complications and death every year in the United States. Given their increased susceptibility to the potential complications of this disease, patients aged 65 and older are considered to be high-risk, but vaccination compliance for this population remain well below state and national goals.

Purpose: The purpose of this project was to increase pneumococcal vaccination rates among adults aged 65 and older in a primary care clinic by increasing patient education.

Methods: An educational intervention was implemented within a large primary care practice located in Central Massachusetts. Educational …

Implementing The Step It Up Walking Program For Hospital Nurses To Increase Physical Movement, Molly Persby

Doctor of Nursing Practice (DNP) Projects

Nurses are at risk for obesity due to shift work, long hours, abnormal eating patterns and job stress. Obesity places nurses at risk for chronic health conditions such as diabetes and coronary artery disease. The goal for this project was to translate evidence of weight loss using the Step it Up Program by launching a pedometer-based walking program for nurses. Measurement methods included pre-intervention measurements of waist and hip circumference in order to calculate waist/hip ratio, and calculate Body Mass Index using a standard BMI Calculator. Fifteen nurses from an inpatient unit of a hospital in southeastern Ohio were issued …

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 …

Obesity Group Medical Visits, Brenda L. Jaeger

Doctor of Nursing Practice (DNP) Projects

Background: Obesity is a major risk factor associated with multiple chronic diseases, presenting a significant global health challenge. Current evidence supports that group medical visits, an alternative format for the provision of primary care, are effective in disease management.

Purpose: The goal of this project was to examine the effectiveness of group medical visits for the management of obesity in primary care.

Methods: Individuals with a BMI greater than 30 participated in a series of six multidisciplinary group medical visits over a 12-week period. Each session included a brief individual medical visit followed by group education and discussion. Topics …

An Evaluation Of An Educational Program For Improving The Accuracy Of Ecg Interpretation In Athletes By Primary Care Clinicians, Stephen F. Segatore Jr

Doctor of Nursing Practice (DNP) Projects

Background: In order to identify athletes at risk for sudden cardiac death (SCD), comprehensive screening that includes ECG interpretation is needed. Many primary care providers, including physicians and nurse practitioners, have reservations about including electrocardiograms (ECG) in the screening process because they lack confidence in their ability to correctly identify normal variants in the ECG of an athlete.

Method: An educational program with previously validated interpretation criteria for normal variants of the athletic heart was presented to providers at a university based healthcare clinic the Northeast. A pre and post design was used to compare the accuracy of ECG …

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 …

Using A Delayed Antibiotic-Prescribing Education Intervention To Prevent Antibiotic Overuse In The Treatment Of Respiratory Tract Infections, Catherine L. Muhia

Doctor of Nursing Practice (DNP) Projects

Background: Antibiotics have been overprescribed to patients with respiratory infection in outpatient clinics in the United States. Antibiotic overuse has led to increased risk for antibiotic resistance and complications related to side effects. A review of the literature suggests that delayed antibiotic prescribing is an effective intervention that can be used to prevent antibiotic overuse. Delayed antibiotic prescribing is an evidence-based strategy where a patient is either issued with an antibiotic prescription and advised to delay filling it or to pick it up at an agreed location only if symptoms persist beyond the expected natural history of illness or deteriorate. …

Motivational Interviewing For Smoking Cessation In Primary Care, Kara E. Pool-Krok-Horton

Doctor of Nursing Practice (DNP) Projects

Smoking is hazardous to human health and continues to be devastating to a patient’s physical health as well as to the entirety of the health care system. Smoking is both a public and personal health concern. The overall prevalence of tobacco dependence has decreased since smoking became a known health hazard, but it remains high in the general population as well as for the patients utilizing primary care in Rutland, Vermont. Nurse practitioners are holistic practitioners and are well suited to assist patients to change unhealthy behaviors. Behavior change, especially smoking cessation, is particularly difficult for patients. Motivational interviewing is …

Higher Fat Low Carbohydrate Diet To Improve Health Related Quality Of Life For Overweight Or Obese Diabetics In A Primary Care Clinic, Breck Baker

Doctor of Nursing Practice (DNP) Projects

Diabetes and obesity are chronic diseases that affect individuals worldwide. The American Diabetes Association (ADA) and the American Heart Association (AHA) have developed guidelines for management of diabetes and obesity. The DNP student examined the use of the Higher Fat Low Carbohydrate (HFLC) diet, which conflicts with these frequently used guidelines. The literature on a HFLC diet suggests positive effects for type 2 diabetics, including weight loss, improved HA1c, lower BMI and no detrimental impact on metabolic markers such as cholesterol, triglycerides, or low and high density lipoproteins. The purpose of this project was to provide type 2 diabetics who …

Mitigating Caregiver Burden, Dorothea S. Frederick

Doctor of Nursing Practice (DNP) Projects

Abstract

Informal caregiving is the most common form of long-term care provided in the United States, and with the projected rapid growth of older adults, informal caregiving will be even more critical in the foreseeable future. In the United States, slightly more than 20% of informal caregivers provide care for more than one care recipient, and 10% provide care for three or more care recipients. Caring for a dependent, older adult patient may have negative effects on physical, psychological, psychosocial, social and financial health of caregivers. Careful assessment of the impact of informal caregiving on the caregiver’s functioning is imperative, …

Education Intervention Of Preconception Screening In Primary Care, Tracy Schuler

Doctor of Nursing Practice (DNP) Projects

Problem: The risk of a poor pregnancy outcome among women of reproductive age in Providence, Rhode Island is indicated by the high rates of unintended pregnancies, low multivitamin use prior to pregnancy, obesity, and smoking. Although recommended, health professionals often fail to routinely screen and educate women of reproductive age for preconception risk factors. Purpose: Evaluate the efficacy of an educational intervention on preconception risk factors, lifestyle modifications, and current screening recommendations; and introduce a preconception tool and education sheet among a population of health care providers. Method: Preconception health material and a modified preconception screening tool …

Improving Adherence To Antihypertensive Medications Among Somali Patients In A Primary Care Clinic, Nimo S. Abdi

Doctor of Nursing Practice (DNP) Projects

Purpose: To evaluate if the use of an evidenced-based educational program delivered to adult Somali hypertensive participants at a community-based clinic in Minneapolis can improve their adherence to antihypertensive medications and blood pressure control. Methods: A convenient sample of 10 participants who met the inclusion criterion consented to take part of the educational program. The Hill-Bone Compliance to High Blood Pressure Therapy Scale was utilized to measure outcomes of the program. In addition to that, each participant’s blood pressure was checked at pre and post intervention. Results: The statistical test of paired t-test was used to analyze data. The pre …

Increasing Medication Adherence In Young Adults With Latent Tuberculosis Infection: An Intervention For Quaity Improvement, Stacy St.Pierre-Thibodeau

Doctor of Nursing Practice (DNP) Projects

Background: Tuberculosis (TB) and latent tuberculosis infection (LTBI) affect a large number of persons worldwide. It is estimated that of the 15 million people infected in the United States, many are unaware of their diagnosis. Purpose: This quality improvement project focused on a more effective medication and self-management regime for treatment at a federal training program in a small rural community in Maine. The target population included young people who had tested positive for TB, many of whom are foreign born and identified as individuals at high risk for disease. Results: Through a supervised and monitored program of education, …