Medicine and Health Sciences Commons^™

Implementation Of The Generalized Anxiety Disorder 2-Item Screening Tool For Adult Patients In An Underserved Outpatient Cardiology Clinic, Leila Joint

Doctor of Nursing Practice Final Manuscripts

Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization …

Implementation Of The American Diabetes Association Pharmacological Approach For Adults With Type 2 Diabetes Mellitus With Cardiovascular Disease, Jose Cedillo

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice project is to improve the utilization of the 2022 ADA pharmacological approach for individuals with Type 2 Diabetic Mellitus (T2DM). The project implementation site was an outpatient clinic in Southern California with a large T2DM Hispanic population. The new ADA guidelines recommend selecting a glucagon-like peptide 1(GLP-1RA) and/or sodium-glucose cotransporter two inhibitors (SGLT-2) when clinically appropriate to reduce the risk of major cardiovascular events in T2DM patients.

Background: According to the American Diabetes Association, ASCVD is the leading cause of morbidity and mortality for adult individuals with T2DM. The use of …

Utilization Of Telemedicine For Follow Up Appointments In Radiation Oncology, Priya Patel

Doctor of Nursing Practice Final Manuscripts

Access to healthcare remains a problem for patients in the United States, especially those who live in remote areas, are immobile, immunocompromised, or are experiencing financial strain. These barriers can lead to missed appointments, putting financial strain on healthcare institutions, and contributing to productivity loss and underutilization of clinic resources. During the COVID-19 pandemic there was a rapid increase in the use telemedicine. Patients were surveyed on the quality of their telemedicine visit at the UCSD Health Moores Cancer Center Radiation Oncology department. The majority of patients would schedule telemedicine appointments in the future, which can reduce the burden on …

Educating And Improving Collegiate Athlete Sunscreen Use, Julia Pederson

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to prospectively evaluate the ability to alter the behavior of young adults by providing sunscreen education and thereby reduce their risk of skin cancer from sun exposure. Twenty-three collegiate athletes ages 18 to 21 years old who were on the university softball team were enrolled. These student athletes were then educated about the impact of daily sun protection and risk factors. The goal was to observe an increase in sunscreen use and increase sun exposure awareness.

Background: Skin cancer is the most frequently diagnosed cancer in …

Implementation Of Clinical Institute Withdrawal Assessment: Alcohol Revised (Ciwa-Ar) Education Program In A Crisis Stabilization Unit, Amanda Dehart

Doctor of Nursing Practice Final Manuscripts

Background: At this time the crisis stabilization Units do not currently utilize the Clinical Institute Withdrawal Assessment: Alcohol Revised tool with patients who may experience Alcohol Withdrawal Syndrome. Patients with alcohol use disorders have a high comorbidity rate with psychiatric disorders (Butterfield, et al, 2020). The Clinical Institute Withdrawal Assessment: Alcohol Revised or CIWA-Ar is currently the most widely used assessment tool in the psychiatric setting when assessing patients who may be experiencing Alcohol Withdrawal Syndrome (Pribék, et al, 2021) .

Purpose of Project: The purpose of this project is to measure pre and post -education knowledge of the registered …

Mental Health Wellness In The Latino Population: Improving Phq-9 Scores In Depressed Patients With Comorbid Type Ii Diabetes, Amanda Cuellar

Doctor of Nursing Practice Final Manuscripts

Major depressive disorder is one of the most common mental health conditions. In the United States, 8.1% of the population have symptoms of depression. Patients with diabetes are 2–3 times more likely to experience symptoms of depression compared to the general population. Having these chronic conditions simultaneously can cause complications in both. The purpose of this study was to improve depression scores for patients who have comorbid type II diabetes. This project took place in a rural community with the Latino population. The nurse practitioner led an evidence-based practice project implementing treatment of depression with medication management, individual psychotherapy, and …

Improve Hypertensive Patients’ Compliance Postgraduation From The Virtual Care Team Program, Marcie Santillan

Doctor of Nursing Practice Final Manuscripts

Background: Virtual Care Team (VCT) began their program approximately 15 months ago to assist their most vulnerable patients with chronic and uncontrolled conditions such as hypertension, diabetes mellitus, and nicotine use disorder. The program follows the patients for a year to help them manage their chronic conditions and comply with chronic management. When the Virtual Care Team followed up a few months after the graduation with some recent graduates, it was found that a small number of patients returned to their pre-Virtual Care Team habits.

EBP Purpose: The purpose of the project is to follow up on those …

Implementation Of A Shared-Decision Making (Sdm) Approach In A Community Based Outpatient Mental Health Clinic, Alexa Vuylsteke

Doctor of Nursing Practice Final Manuscripts

Purposes/Aims: The purpose of this Doctor of Nursing Practice (DNP) project is to implement an evidence-based SDM approach in a culturally diverse community mental health clinic in order to increase patient-provider collaboration and improve patient autonomy and engagement in decision making processes of care in a mental health setting.

Rationale/Background: According to the Substance Abuse and Mental Health Services Administration (SAMHSA), shared decision-making (SDM) is a collaborative communication approach between patient and provider that aims to help people in treatment work together to have informed, meaningful discussions about their health care decisions. SDM is an evidence-based approach to encourage and …

Measuring The Effectiveness Of Antidepressant Treatment By Implementing Beck's Depression Inventory (Bdi), Azeem Anjum

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice project integrates a structured periodic depression evaluation follow-up protocol for patients diagnosed with Major Depressive Disorder who have been prescribed antidepressant(s) at an outpatient mental health clinic. The purpose of this DNP project is to standardize the method of treatment progression monitoring to improve the timeliness of change detection and subsequent treatment adjustments using the Beck Depression Inventory (BDI) Scale.

Background: According to the World Health Organization (WHO), MDD is one of the most common mental health conditions affecting approximately 280 million people globally and 17.5 million adults in the United States. (WHO, 2021). The economic …

Improving Access To Colorectal Cancer Screening In Latino Communities In California: Eliminating Transition To Practice Hours For Nurse Practitioner Full Practice Authority, June Spilburg

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence based practice Doctor of Nursing Practice (DNP) project was to investigate barriers to colorectal cancer screening in young Latinos living in California. The goals of this project included examining current trends in colorectal cancer in young Latinos, factors which affect access to care, and the current and future state of the California primary health care provider workforce. The aim of this project was to make recommendations regarding strategies to improve access to colorectal cancer screening among Latinos in California.

Background: Early onset colorectal cancer (EO-CRC) is increasing in Latino communities, with colorectal screening rates …

The Future Of Cognitive Dysfunction In Elderly Patients: A Clinical Perspective With Recommendations, Laura Taylor

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

Feasibility Of Family Focused Obesity Screening In Primary Care, Adrianne Griffiths

Doctor of Nursing Practice Final Manuscripts

Background: Obesity is associated with serious medical conditions including diabetes, hypertension, and heart disease. It also contributes to decreased productivity at work and school, financial strain, and reduced quality of life.

Purpose of Project: To address this problem, a nurse practitioner-led screening and intervention program was piloted at a primary care clinic in southern San Diego. The tool provides a standardized method for screening individuals and their families for nutrition and physical activity deficits associated with obesity, as well as appropriate and effective interventions to prevent and manage obesity.

Methods: The Family Nutrition and Physical Activity (FNPA) screening tool is …

A Comparison Of Suprathel Burn Dressing Vs Standard Care On Length Of Hospitalization, Pain Scores, Opioid Use, Treatments, And Outcomes., Rakiema T. Sellars-Pompey, Anthonia Okoh

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidenced-based practice Doctor of Nursing Practice (DNP) project was to determine the impact and efficacy of using Suprathel artificial wound and burn dressing on patients treated at a UC San Diego Health Regional Burn Center for second-degree burns. The primary goal of this project will be to evaluate the impact of using Suprathel on hospital length of stay; compare wound infection rates, pain score, and morphine equivalent use; and to identify the cost-effectiveness of the Suprathel artificial wound and burn dressing.

Background: Burns are a global health concern causing significant morbidity and mortality, …

Be Kind To Your Mind: The Use Of Mobile Based Applications To Reduce Stress And Improve Health Outcomes, Akira Hanson Finn

Doctor of Nursing Practice Final Manuscripts

Now more than ever mental health is in the spotlight on a global scale. Professionals from a variety of different disciplines are being encouraged to evaluate several different coping techniques in order combat the magnitude of societal crisis being discovered post-pandemic. At the top the list is Mindfulness-based interventions. The concept of mindfulness practices is nothing new. Evidence suggests it has existed for thousands of years; however, it is getting more notoriety in the past decade due to increasing expansion of mobile-based applications. These types of technology driven applications offer an easily accessible, convenient, and trackable way for individuals to …

Exercise As A Prescription For Patients With Depressive Disorders: A Quality Improvement Project, Sydney Roscoe, Rachelle Pace

Doctor of Nursing Practice Final Manuscripts

Purpose: The aim of this Doctor of Nursing Practice project was to increase exercise counseling rates in the treatment of depression by (1) implementing a focused educational training program and (2) understanding factors that impacted utilization of the practice change.

Background: Approximately 280 million individuals suffer globally from depressive disorders. Depression remains the fourth leading cause of disabilities, significantly contributing toward the global burden of disease by increasing morbidity and mortality risk. Psychopharmacology and psychotherapy are current gold standards of treatment; however, providers often overlook the significant role exercise serves in reducing depressive symptoms and severity, as it remains underutilized. …

Increasing Utilization Of Ivc Pocus For Patients With Sepsis, Alexis Arreola

Doctor of Nursing Practice Final Manuscripts

Background: Sepsis is the cause of death of half of all admissions in the United States (Rhee, 2019). Medicare has adopted guidelines from the surviving sepsis campaign and labeled them the “The Severe Sepsis and Septic Shock Management Bundle (SEP-1) guideline to address the care required to try to reduce mortality involving septic patients. This bundle has an all or none feature that suggests every patient presenting with septic shock receives 30 ml/kg of normal saline as a bolus. (Medicare, 2021). One must document medical reason for not providing this bolus. Inferior vena cava point of care ultrasound (IVC POCUS) …

Improving Patient Self-Efficacy, Readiness, And Completion Of Advance Care Planning Documents Using Prepare Documents And Advance Care Planning Group Referral, Marie Vassiliadis

Doctor of Nursing Practice Final Manuscripts

Advance Care Planning (ACP) is an ongoing discussion about medical decision making between a provider, patient, and support person. ACP can also include legal documentation in the form of an advance directive (AD). Nationally, only 36.7% of adults complete any form of AD for end-of-life care. Recently, ACP has become an important quality metric that many organizations are prioritizing. The purpose of this evidence-based project is to improve ACP readiness, self-efficacy, and documentation among patients at an internal medicine clinic using the PREPARE program and referral to an ACP group meeting. PREPARE for Your Care is an online program aimed …

Improving Nursing Student Retention: Early Identification Of Determinants Causing Attrition In Nursing Academic Programs, Tennille Gifford

Doctor of Nursing Practice Final Manuscripts

Introduction: Student success in higher education is a vital focus for the health of a community and the improvement of an individual’s life. It is equally detrimental if a student leaves an educational program without a degree. The purpose of this project was to improve the early identification of students at risk of attrition in a nursing program by using an electronic dashboard interfaced with a self-reporting student survey to identify determinants that are statistically significant factors for student attrition. Background: The current accreditation benchmark for nursing program completion is 70% for Bachelor of Science in Nursing degrees. Concordia St. …

Better Sleep, Brighter Mornings: A Sleep Hygiene Protocol For Older Adults As A Quality-Of-Life Enhancement, Melissa Baltazar

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to emphasize the importance of and educate patients on primary prevention techniques for sleep hygiene to use as a tool to enhance quality of life by increasing patient’s self-reported sleep quality.

Background: Sleep patterns change as we age, however, aging itself is not necessarily a cause of sleep problems. Sleep is one of the most important activities for a person’s health and overall well-being. A growing body of literature shows that not enough sleep and poor sleep quality is associated with hypertension, heart disease, stroke, diabetes, …

Implementation Of A Follow-Up Procedure For Patients Treated With Transcranial Magnetic Stimulation At A Primary Care Clinic, Brooke Marino

Doctor of Nursing Practice Final Manuscripts

Background: Depression is one of the most common mental disorders in the United States. In 2020 alone, an estimated 21 million adults experienced at least one depressive episode, representing 8.4% of all U.S. adults. Transcranial magnetic stimulation (TMS) therapy is a cutting-edge option for treatment-resistant depression, and up to 70% of patients treated with TMS will achieve at least a 50% reduction in depression symptoms. For some, these results are long-lasting; for others, depression symptoms may return. For those who experience return of their depression symptoms, more TMS may be necessary. Currently, there is no standardized follow up procedure after …

Implementation Of The Diet Readiness Test To Assess Self-Efficacy And Education Effectiveness In Overweight Women, Tatjana Ilich

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based Doctor of Nursing Practice (DNP) project was to assess perceived self-efficacy in overweight women who are participating in a weight loss program and the effectiveness of education being provided using the Diet Readiness Test (DRT).

Background: Obesity is a rapidly growing public health problem affecting an increasing number of countries worldwide because of its prevalence, costs, and health effects. Among women between the ages of 40 and 60, more than 80% report that they are either trying to lose weight or trying to maintain weight. The overall prevalence of obesity was similar among men …

Mantram For Mamas: A Pilot Study For Postpartum Women, Ritamarie Smedile

Dissertations

Objective: This pilot study launched an online Mantram Repetition Program (oMRP) using a virtual health portal that aimed to explore online portal accessibility, oMRP acceptance, and overall interface satisfaction among a sample of postpartum women.

Background: Postpartum depression remains one of the most common and severe childbirth complications, affecting more than 13% of women during the first three months after childbirth. Cognitive or behavioral talk therapy sessions and medication are the most frequently recommended treatments to alleviate symptoms. Although effective, women tend not to enroll or adhere to these modalities, suggesting they need alternative treatment plans. A possible alternative, mirroring …

Implementing Outpatient Screening Of Adult Patients At High Risk For Peripheral Artery Disease, Coral Roseberry

Doctor of Nursing Practice Final Manuscripts

Background: Peripheral artery disease (PAD) is a prevalent chronic vascular disease that remains often underdiagnosed and inadequately treated. The development of PAD increases both with age and with the presence of modifiable and non-modifiable risk factors. Risk factors for PAD include smoking, diabetes, hypertension, hyperlipidemia, and chronic kidney disease. Furthermore, PAD can be an indicator of systemic atherosclerosis which is associated with coronary artery disease, carotid stenosis, and cerebrovascular disease. Undiagnosed obstructive PAD contributes to damaging atherosclerotic sequelae such as claudication, ulcers, infections, peripheral neuropathy, and amputations. It is common for PAD to exist in the absence of symptoms; therefore, …

Assessing Genomic Literacy In Advanced Practice Nursing Students Before And After An Intervention, Guiselle Palomera

Doctor of Nursing Practice Final Manuscripts

Introduction

The purpose of this evidence-based Doctor of Nursing Practice (DNP) project was to examine genetics and genomics literacy in advanced practice nursing students before and after an intervention.

Background

As genomics continue to play an emerging role in healthcare, and advancements are introduced into clinical practice, it is critical that nurses be competent in genetics and genomics concepts. There is a fundamental need to incorporate genomics education into nursing school curriculum. However, studies have shown that the majority of faculty across nursing schools in the United States are ill-equipped to teach genetics and genomics concepts. Furthermore, many interventions to …

A Prescription For Exercise In Adolescents: A Pilot Project, Alexa Sikalis

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence based practice project was to increase physical activity (PA) times in pediatric patients who were not meeting the recommended guidelines of 60 minutes per day of activity. The goal was to educate adolescents on the benefits of exercise in order to increase their overall PA, even if it did not meet the recommended 60 minutes per day. The implemented education was also intended to motivate patients to establish healthy habits and minimize risks of poor health outcomes.

Background: Adolescence is characterized by development of neuronal plasticity and establishment of behavioral patterns. PA …

Algorithmic Bias: Causes And Effects On Marginalized Communities, Katrina M. Baha

Undergraduate Honors Theses

Individuals from marginalized backgrounds face different healthcare outcomes due to algorithmic bias in the technological healthcare industry. Algorithmic biases, which are the biases that arise from the set of steps used to solve or analyze a problem, are evident when people from marginalized communities use healthcare technology. For example, many pulse oximeters, which are the medical devices used to measure oxygen saturation in the blood, are not able to accurately read people who have darker skin tones. Thus, people with darker skin tones are not able to receive proper health care due to their pulse oximetry data being inaccurate. This …

Special Education: Inclusion And Exclusion In The K-12 U.S. Educational System, Erik Brault

Dissertations

The U.S. Department of Education defines students with disabilities as those having a physical or mental impairment that substantially limits one or more life activities. Previous research has found that students with disabilities placed in inclusive environments perform better academically and socially compared to students with disabilities who are placed in segregated environments. Yet, we know that inclusion in K-12 general education classrooms across the country is not consistently implemented.

The purpose of this study was to better understand the effects, if any, of general education high school teachers’ personal and professional experiences and knowledge on their attitudes toward educating …

Queering Healthcare Equity: Exploring How Two Community Health Centers That Specialize In Lgbtq Healthcare Frame Cultural Competence, Tommy Royston

Dissertations

Despite increased advocacy and funding, significant inequities in healthcare access, quality of care, and health outcomes have continued to persist for lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) communities. Intersecting marginalized identities such as race, gender, and disability compound health inequities faced by LGBTQ folx. These inequities are not random; rather, they result from deeply embedded homophobia, transphobia, ableism, and racism that pervade the U.S. healthcare system. An exploratory comparative case study was completed using qualitative data collection methods (i.e., key informant interviews, focus groups, and document analysis) to investigate how two California-based Federally Qualified Health Centers (FQHCs) that specialize in …

Nursing Education In Complementary Alternative Modalities: A Case Study, Deborah Bird

Dissertations

Purpose: The purpose of this embedded case study was to describe the preparation for and utilization of complimentary alternative modality (CAM) interventions by an experienced Doctor of Nursing Practice (DNP) prepared nurse practitioner (NP) working in an outpatient setting.

Background: Given the widespread use of CAM by the American public and the potential complications involved in combining CAM and standard medical care, a lack of educational preparation in CAM interventions by NPs delivering primary care in outpatient health care settings represents both a potential risk and a missed opportunity to provide holistic patient care. Such a lack of knowledge also …

3d-Wound Imaging: Precise, Consistent, And Efficient, Aubrey Halili

Doctor of Nursing Practice Final Manuscripts

Background: The most common method of obtaining wound measurements is the hand-ruler method. Studies show that the hand-ruler method results in the most inaccurate measurements with the lowest interrater reliability. Studies also show that using 3D-wound imaging yields the most accurate measurements with the best interrater reliability. 3D-wound imaging technology also increases efficiency by allowing users to obtain images and document assessments using one device at the bedside.

Purpose: The purpose of this project is to make the process of assessing wounds more efficient by decreasing the time spent on photographing, measuring, and documenting wound assessments by implementing the use …