Family Medicine Commons^™

The Impact Of A Blood Pressure Reduction Program In Optimizing Control Of Hypertension Amongst Adult Females In An Outpatient Ambulatory Clinic, Brooke Englert

DNP Projects

Background: Hypertension (HTN) is a public health problem that, when well-controlled, can significantly reduce the risk of stroke, coronary heart disease, heart failure and death. Effective patient-provider communication strongly incentivizes an improvement in medical outcomes. Communication with patients can often be effectively delegated to other clinical staff, such as registered nurses (RNs) or clinical service technicians (CSTs) (Tavakoly Sany, Behzhad, Ferns & Peyman, 2020).

Purpose: Given the increased risk of all-cause and cardiovascular disease mortality of uncontrolled HTN, the purpose of this study was to implement and evaluate a standardized, evidence-based practice intervention via communication between APRN providers and patients …

Evaluating Kentucky Advanced Practice Registered Nurses’ Confidence, Comfort, And Knowledge Levels Regarding Dermatology Care After A Web-Based Video Training, Victoria Hayden

DNP Projects

Background: It can take an average of 38.9 days to see dermatology from referral to initial appointment. As a result, delays in diagnosis and treatment of life-threatening conditions such as malignant melanoma could occur. Primary care providers frequently refer patients for benign conditions that can be appropriately managed in the primary care setting; often due to lack of knowledge or confidence in their clinical management skills. Educational resources equip providers with the knowledge and tools to feel confident in their management of various skin conditions in a primary care setting. Purpose: The purpose of this project was to …

Evaluation Of Patient And Clinical Staff Perceptions Of Screening For Social Needs In An Underserved Population, Alysha Greenwell

DNP Projects

Abstract

Background. Despite ample strong evidence linking social determinants of health (SDOH) and unmet social needs to higher healthcare costs and worse health outcomes across the lifespan, only 16% of healthcare practices screen their patients for social needs. Various barriers contribute to low screening rates, including uncertainty about best methods for screening, the amount of time it takes to screen, and lack of confidence in knowing what to do once needs have been identified. As movements toward value-based models of care change the healthcare landscape, healthcare systems must find practical and effective methods to effectively screen for social needs utilizing …

Psychiatric Medications: Does Education Affect Medication Prescriptions?, Surina M. Narine, Mary D. Ramos, Sarah Chu

Symposium of Student Scholars

Background: There is a lack of research on racial challenges among underrepresented adolescents regarding prescription drug use for mental illnesses. Purpose: This study addressed the following question: In adolescent minorities, how does education about racial disparity and culture affect the stigma and number of prescriptions written for psychiatric medications? This evidence-based practice project aimed to identify if racial awareness directly impacts the amount of psychiatric medication prescribed for adolescent minorities. Methods: Literature reviews analyzed qualitative and quantitative data to provide correlating information on racial disparities and psychotropic medications. This study examined the following possible factors for decreased prescribed drugs within …

Use Of Text Messaging For Type Two Diabetes Management In Patients Over Sixty-Five, Charles Head

Master of Science in Nursing Family Nurse Practitioner

Why is there a need for tight glucose control for diabetics sixty-five years old or older? Tight control of glucose which can be trended as a 90-day snapshot of blood sugar control is measured using HgA1C levels(Centers for Disease Control and Prevention, 2019). HgA1c levels under six percent in diabetics have been shown to reduce diabetic complications that be detrimental to health(Krapek et al., 2004). Adults aged sixty-five years old or older are also at greater risk for the development of acute and chronic diseases that are a result of poor blood sugar management(Leung et al., 2018). Adherence to prescribed …

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

Telehealth And Hospital Readmissions For Heart Failure Patients: A Literature Review, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Currently heart failure affects over six million people and is expected to increase to over eight million people by 20230. The US Census Bureau estimates over 60 million people live in a rural setting. This literature review seeks to determine the state of the science regarding the utilization of Telehealth to reduce heart failure readmissions in rural areas.

Implementing The Use Of The Emergency Severity Index Triage Tool In Urgent Care, Sakeena Spencer

Doctor of Nursing Practice Projects

Background: The urgent care sector has quickly grown in the last decade. Patients who visit healthcare facilities seeking treatment for exacerbations of chronic conditions or episodic illnesses such as asthma without scheduled appointments receive healthcare services from Urgent Care Centers (UCC) or Emergency Departments (E.D.s). Upon visiting the UCC, these patients report life-threatening symptoms; hence require immediate medical attention. UCC healthcare workers should distinguish between non-acute and acute patients to prioritize providing healthcare to patients, ensuring they are not at risk for fatal outcomes. Using the Emergency Severity Index (ESI) triage tool while delivering healthcare services to these patients has …

Global Child And Family-Centered Care Fellowship, Education And Mentorship For Pediatric Healthcare Professionals: A Literature Review, Ashley Zheng, Bobbijo Pansier

Patient Experience Journal

Child- and family-centered care (FCC) is increasingly accepted and implemented to optimize the healthcare experience for patients, their families, and healthcare professionals. Standish Foundation for Children, a 501(c)(3) non-profit, has designed and piloted a fellowship to educate pediatric healthcare professionals in FCC & psychosocial care via an inquiry and mentorship model in Tbilisis, Georgia. This review aimed to evaluate and synthesize existing literature on psychosocial and FCC mentorship for pediatric healthcare professionals in four parts: ongoing need, effects on healthcare professionals, effects on children and their families and/or caregivers, and in cross-country healthcare settings. Reviewers searched open-source databases for articles …

Quality Improvement: Piloting A Pediatric Obesity Prevention Screening Tool And Intervention In A Family Practice Setting., Erin Shaye Semeyn

Doctor of Nursing Practice Papers

Background: In the United States today, nearly one third of children fall into the category of overweight or obese. Because it is extremely difficult to treat childhood obesity once it occurs, prevention is the optimal approach to childhood overweight and obesity (Brown & Perrin, 2018; Cooper & Mandel, 2020). An ideal time to address obesity prevention health behaviors is during pediatric primary care visits. Since the COVID-19 pandemic began in the United States in 2019, visits to primary care offices, including visits to an urban university-based family practice clinic in Kentucky, dropped as some pediatric patients and their caregivers worried …

Life Matters, Marina Fischer

Dissertations

Problem: One of the challenges facing many primary care providers is managing hypertension. Hypertension contributes to cardiovascular disease events. Consequently, the high occurrence of hypertension related visits signifies a clinical practice gap in hypertension management resulting in substandard blood pressure outcomes. The purpose of this clinical scholarship project was to assess the difference of pre and post Quality of Life Scale (QOLS) scores in a hypertensive population.

Methods: This quality improvement project used a longitudinal, observational design with prospective data collection. The sample included newly diagnosed hypertensive adults ages 21 to 64 years old. The sample was administered the World …

Treatment Evaluation Of Iron Deficiency Anemia In Women Of An Underserved Community, Bukola Olusanya

Doctor of Nursing Practice Final Manuscripts

Background/Purpose: Iron deficiency anemia (IDA) is the most common micronutrient deficiency globally. More than 20% of women experience IDA during the reproductive year. As the first-line treatment in IDA, oral iron supplement (IOS) is associated with gastrointestinal side (GI) effects, and it is often a barrier to achieving normal hemoglobin (Hb) and serum ferritin (SF) levels. Ineffective treatment fueled by a lack of guidelines increases the dilemma of dosing frequency in primary care, leads to poor quality of life, and increases the burden of anemia.

Intervention: Evidence showed that intermittent OIS is as effective as daily dosing. It is associated …

The Outcome Of A Multidimensional Intervention Strategy For The Management Of Generalized Anxiety Disorder In An Internal Medicine Setting, Nicholas Davidson

Evidence-Based Practice Project Reports

Anxiety disorders are very prevalent in the United States. The most common type, Generalized Anxiety Disorder (GAD), affects 6.8 million adults every year. GAD can cause significant deficits in a person’s ability to function, decrease their quality of life and increases a person’s risk of attempting suicide. The purpose of this evidence-based practice (EBP) project was to improve the outcomes of adults diagnosed with GAD in an internal medicine setting by implementing a protocol composed of a combination of interventions. A thorough literature search was conducted to find the best available evidence to support the project. A total of 11 …

A Multimodal Approach To Decreasing Hesitancy And Increasing Uptake Of The Covid-19 Vaccine In The Family Care Setting, Meghan Zwierzynski

Evidence-Based Practice Project Reports

Since December 2019, the coronavirus disease 2019 (COVID-19) has swept across the world, infecting and killing millions of people, making it one of the worst pandemics in history (WHO, 2021). However, the rates of confirmed cases and deaths have slowed since the discovery of the COVID-19 vaccine. The purpose of this evidence-based practice (EBP) project was to decrease vaccine hesitancy and increase uptake of the COVID-19 vaccine in the family care setting. The Iowa Model-Revised (Iowa Model Collaborative, 2017) is a practical, effective multi-step change process that acted as a guide for the EBP project. A review of literature showed …

Back To The Basics With Smart Goals: A Multimodal Intervention For Adults Who Have Type 2 Diabetes, Alyssa L. Snyder

Evidence-Based Practice Project Reports

Diabetes, the seventh leading cause of death in the United States (Centers for Disease Control and Prevention [CDC], 2020a) and the ninth leading cause of death worldwide (World Health Organization [WHO], 2020), has increased by 70% over the last two decades (WHO, 2020). Type 2 diabetes (T2D), the most prevalent type accounting for 90% to 95% of diagnosed cases (CDC, 2020a), affects individuals of all ages and often results in major health problems including stroke, heart attack, and kidney disease. The purpose of this patient-centered, evidence-based practice (EBP) project was to evaluate the effectiveness of a multimodal intervention on hemoglobin …

A Survey To Highlight Areas Of Focus For Patient Care In Settings Utilizing Medical Interpretation, Azayzel Deregis

Undergraduate Honors Theses

This thesis recounts my personal experience working as a volunteer medical interpreter for the Language and Culture Resource Center at East Tennessee State University. The result of my time spent volunteering as a medical interpreter, shadowing professional medical interpreters, and witnessing patient-provider interactions during interpreted sessions was an inspiration to study medical interpretation further and delve into the challenges faced by patients who require medical interpreters. During my time researching this topic, I found that the United States is severely lacking in Spanish medical interpreters—with some healthcare facilities employing no medical interpreters—even though the size of the Hispanic population is …

Interventions To Improve Adherence To Recommended Diabetic Retinopathy Screening In Adult Patients With Diabetes Mellitus: A Scoping Review, Clare Anderson Bsn, Rn, Dnp, Fnp, Sarah May Bsn, Rn, Dnp, Fnp, Diana Dedmon Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Diabetic retinopathy (DR) is the leading cause of blindness in adults. Current guidelines recommend that all patients with type 2 diabetes mellitus (T2DM) have a DR screening (DRS) upon diagnosis of T2DM and then annually, but the adherence rate is only approximately 60%. This scoping review aims to evaluate the effectiveness of primary care providers (PCPs) employing strategies to increase compliance with annual DRS among adult patients with T2DM.

Methods Between September 2021 and January 2022, a literature review was performed to collect studies evaluating interventions to increase adherence to DRS. Individual searches of PubMed, SCOPUS, and CINAHL were …

Annual Hepatitis C Screening Qi: A Scoping Review, Sadiat Omowunmi Adebiyi Bsn, Rn, Sakinah Shaw Bsn, Rn, Tracy Mcclinton Dnp, Ag-Acnp-Bc, Sharon Little Dnp, Fnp-Bc, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Despite the surge in HCV prevalence among pregnant women and the threat of perinatal HCV transmission, infants exposed to HCV in the United States are inadequately screened (Chappell et al., 2018). It is estimated that between 4% and 8% of babies exposed to HCV during pregnancy become infected (Watts et al., 2017). Incorporating Hep C screening with other mandated prenatal screening will play an essential role in reducing the complications associated with Hep C transmission to the newborn.

Methods Article search was done in the first three weeks of the fall 2021 semester, and a total of 63 articles …

A Physical Therapy Mobility Checkup For Older Adults: Feasibility And Participant Preferences From A Discrete Choice Experiment, Dalerie Lieberz, Hannah Borgeson, Steven Dobson, Lindsey Ewings, Karen Johnson, Kori Klaysmat, Abby Schultz, Rachel Tasson, Alexandra L. Borstad

Journal of Patient-Centered Research and Reviews

Purpose: Physical performance measures, like walking speed, identify and predict preclinical mobility disability but are rarely used in routine medical care. A preventive model of care called Mobility Checkup is being designed to reduce mobility disability in older adults. This study had two purposes: 1) determine feasibility and outcomes of the Mobility Checkup, and 2) identify preferences of older adults regarding this model of care using a discrete choice experiment.

Methods: Adults over 55 years of age were recruited from the community. In the study’s first phase, participants completed a Mobility Checkup, with feasibility evaluated using 6 criteria. In the …

Increasing Awareness Of Personal Harm Reduction Interventions In The Clinical Setting: A Quality Improvement Project, Shawn Theberge

DNP Scholarly Projects

Abstract

The ever-rising concern for safety in the healthcare setting has become increasingly prevalent and levels of hostility and violence more publicly visible. Over the last decade both patients and clinicians have been targeted in healthcare facilities at record levels. These incidents have created an environment of not only risk but increased anxiety and feelings of uncertainty for most clinical personnel. The study will initially measure clinician’s viewpoint of the clinical setting that they work in; and over the span of the project, track and evaluate the effects of the interventions on clinicians’ overall feelings and perceptions. The expected outcome …

Optimizing Secure Patient Messaging Workflow In A Vermont Primary Care Clinic, Kimberly S. Oleary

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

Optimizing Secure Patient Messaging Workflow in a Vermont Primary Care Clinic

Kim O’Leary, DNPc, RN

DNP Advisor: Margaret Aitken, DNP, AGNP, ANP-BC

Site Mentor: James Williamson, MHA, Site Supervisor, Adult Primary Care

Background: Secure patient messaging is a popular tool designed for non-urgent questions, yet patients sometimes use it to relay urgent concerns. As office workflows tend to prioritize responses to other methods of communication, this presents a potentially unsafe situation in which clinical staff may not respond to these urgent messages in a timely manner.

Purpose: To develop a methodology to improve the timeliness, effectiveness, and safety of secure …

Evaluation Of A Comprehensive Diabetes Mellitus Protocol At A Rural, Federally Qualified Health Center In Southern West Virginia, Hannah D. Davis

Graduate Theses, Dissertations, and Problem Reports

Background: Diabetes mellitus is a chronic disease that affects nearly 34 million Americans. In rural Appalachia, the population is affected disproportionately at a rate of 14% compared to the national average of 10%. Diabetes is a lifelong, chronic condition managed best by a multidisciplinary team-based approach to achieve optimal disease control. Best practices in the care of diabetes support the use of evidenced based care protocols and leveraging technology to decrease the burden of disease. Type 2 diabetes mellitus (T2DM) is the most common type, making it the focal population for evaluation.

Purpose: The purpose of this project was to …

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

Adverse Childhood Experiences And Urinary Incontinence In Elementary School Aged Children, Amanda Jill Travis Msn, Fnp-C, Margaret C. Harvey Phd, Aprn, Acnp-Bc, Chfn, Michelle Rickard Dnp, Apnp-C

Doctor of Nursing Practice Projects

Purpose/Background: Adverse Childhood Experiences (ACEs) have an impact on health throughout the lifespan (Filletti et al., 1999; Hughes et al., 2017). These experiences range from physical and mental abuse, substance abuse in the home, parental separation or loss, financial instability, acute illness or injury, witnessing violence in the home or community, and incarceration of family members (Hughes et al., 2017). Understanding and screening for ACEs in children with urinary incontinence can help practitioners identify psychological stress as a potentially modifiable risk factor.

Methods: A 5-month chart review was performed identifying English speaking patients ages 6-11 years presenting to the outpatient …

The Mediating/Moderating Role Of Cultural Context Factors On Self-Care Practices Among Those Living With Diabetes In Rural Appalachia, Brittany L. Smalls, Adebola Adegboyega, Ellen Combs, Matthew Rutledge, Philip M. Westgate, Md. Tofial Azam, Felipe De La Barra, Lovoria B. Williams, Nancy E. Schoenberg

Family and Community Medicine Faculty Publications

Background

The aim of this study was to examine whether cultural factors, such as religiosity and social support, mediate/moderate the relationship between personal/psychosocial factors and T2DM self-care in a rural Appalachian community.

Methods

Regression models were utilized to assess for mediation and moderation. Multilevel linear mixed effects models and GEE-type logistic regression models were fit for continuous (social support, self-care) and binary (religiosity) outcomes, respectively.

Results

The results indicated that cultural context factors (religiosity and social support) can mediate/moderate the relationship between psychosocial factors and T2DM self-care. Specifically, after adjusting for demographic variables, the findings suggested that social support may …

Community-Dwelling Older Adult Fall Prevention Improvement Project, Evan Edminster Bsn, Rn, Cfrn, Tcrn, Cen, Nhdp-Bc

Master's Projects and Capstones

Abstract

Problem: Ground-level falls among community-dwelling adults 60 years and older are significant and contribute to adverse health outcomes such as fractures, functional decline, disability, and death. Additionally, falls among community-dwelling older adults are the number one mechanism of injury seen at a Northern California Level II trauma center. Falls often lead to post-fall fear, activity restriction, and physical deconditioning, further compounding fall risk.

Context: When trauma centers provide targeted outreach and screening for unmanaged health risks such as falls, they reduce unnecessary disability and premature death in the local population. Reducing total fall victim numbers and fall recidivism also …

Physician Burnout Among West Virginia Primary Care Providers, Kevin S. Mccann, Adam Baus, Joanna Bailey, Laura Boone, Jennifer Boyd, Martha Cook-Carter, Dan Doyle

Marshall Journal of Medicine

Introduction

Work related burnout is highly prevalent in US physicians and linked to adverse effects on patients, providers and organizations. This study measures burnout in West Virginia (WV) primary care providers, allowing for comparison of results to a similar, recent study of US physicians.

Methods

Anonymous survey through email that included Maslach Burnout Inventory, demographic, workload, and practice characteristics. Responses were analyzed using JMP Pro 13. Analysis used JMP Pro 13 for descriptive statistics, chi-square and regression modeling.

Results

Subjects = 110, female/male ratio 1.4, all primary care physicians (PCP), or advanced practice registered nurses or physician assistants (APRN/PA). PCP …

Implementing An Antibiotic Stewardship Education Program To Decrease Antibiotic Prescriptions In An Urgent Care Clinic, James Gramling

Doctor of Nursing Practice Projects

Antibiotics are often prescribed for respiratory infections. These infections often have a viral rather than a bacterial source. Overuse of antibiotics is associated with increased potential for adverse effects, increased healthcare costs, and increasing antibiotic resistance. The purpose of this DNP project was to determine if implementing an antibiotic stewardship program at an urgent care clinic would decrease the number of antibiotic prescriptions written for acute respiratory tract infections. An educational session consisting of didactic and PowerPoint presentations was provided to each provider at the urgent care clinic. Medical records were reviewed for four weeks after completion of the session …

Increasing Staff Awareness And Screening Practices For Adverse Childhood Experiences At A Primary Care Clinic, Kayla Wright

Doctor of Nursing Practice Projects

Adverse childhood experiences (ACEs) are present in approximately 60% of the adult population in the United States. There is a correlation between adverse childhood experiences and chronic health conditions as adults. Despite the evidence showing this correlation, there is a lack of screening for ACEs in the primary care setting. Many primary care providers and staff are unaware of ACEs or the correlation with chronic health conditions and substance abuse and, therefore, do not understand how to or recognize the benefits of screening in primary care. With education for providers and staff, primary care is the ideal setting to perform …

The Ways In Which Women’S Suffrage Affected Healthcare, Madison M. Weber

The Review: A Journal of Undergraduate Student Research

The 19th Amendment had and continues to have a major impact on women’s healthcare in the United States. Prior to suffrage, women had little to no ability to voice their thoughts on and change policies that regarded their own health. This essay addresses the way in which the vote both directly and indirectly impacted healthcare; including workplace conditions, maternal and reproductive rights, racial disparities, political advocacy and healthcare, the different waves of feminism, and how this has all affected modern healthcare for women. From progressive articles being published in women's magazines, to the establishment of marital rape, to the availability …