Public Health and Community Nursing Commons^™

Video-Based Diabetes Education For A Culturally Diverse Population, Heather Harris

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

Immigrants and refugees represent an underserved population in need of quality, accessible, and culturally appropriate healthcare and education. Diabetes is a chronic condition frequently seen in this population. The author utilized the Wagner Chronic Care Model (CCM) as a theoretical framework for planning diabetes education delivery in this diverse population. Studies report significant health disparities in diabetes care and subsequent poor diabetes quality indicators in refugees and immigrants. Research has found that culturally sensitive diabetes education can improve diabetes outcomes in ethnically diverse populations. The author implemented a translational project to develop and evaluate a video-based diabetes health education intervention …

Transitions Of Care: Implementing Early Follow-Up Appointment To Help Decrease Readmission Rate, Lualhati Espina Dursun

Master's Projects and Capstones

Abstract

Problem – The rate of readmission in the country is at a severe level. According to CMS, in 2017 the average national readmission rate was 18.4%(CMS, 2018). Hospitals are penalized for unnecessary readmissions (HRRP, 2018). In addition to the financial burden of readmissions, quality of life is decreased with readmission.

Context – Early or timely outpatient follow-up after hospitalization has been projected as a means of decreasing readmission rates.

Interventions – Integrating follow-up appointment to the current care transition - HUB process as a means in reducing readmission rates.

Measures & Results – Identified high-risk patients that need timely …

Improving Breastfeeding In Rural Tanzania Using Bardach’S Policy Analysis Methodology, Katherine Skiff

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under five years (U5Y) compared to all other preventive interventions. The World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. Shirati hospital, in rural Tanzania, does not have a breastfeeding policy. Bardach’s 8-Fold Pathway for policy analysis methodology (adapted by Collins for health policy) was used to evaluate three promising breastfeeding policies to improve compliance with this recommendation. They include …

Staff Retention Through Standardized Training Materials In Adult Primary Care Clinic, David Smith

Master's Projects and Capstones

As non-profits, community health clinics face a unique set of challenges. Primary amongst these is a shortage of financial resources. Staff turnover, including Registered Nurses (RNs) and Medical Assistants (MAs), can result in avoidable increased wage costs related to training of newly-hired RNs/MAs (clinical staff). Retention of experienced RNs/MAs can be directly correlated with job satisfaction, the obverse of which is job frustration. The intent of this RN/MA training and orientation project is to ameliorate frustration related to a lack of informational resources and clear competency expectations. Upon completion and implementation, project efficacy will be assessed via four longitudinal measures: …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Strong Recommendation Towards Hpv Vaccination, Danielle Bogue

Doctor of Nursing Practice Projects

Risk of future HPV related cancers remains high in individuals unvaccinated against HPV, leading to too many people dying from this preventable cancer. However, primary care providers’ strong recommendation to vaccinate and family education about HPV and vaccine efficacy have a positive impact on a family’s decision to vaccinate. The setting for this project was a Midwest suburban family healthcare practice. This process was implemented by providing the guardian with a handout, a short video on HPV, a question and answer period with the provider, and ended with the provider giving a strong recommendation towards HPV vaccination. Of the 35 …

Suicide In High School Students And The Effectiveness Of State Suicide Prevention Plans, Patricia G. Wilson

Nursing Theses and Dissertations

With suicide rates rising across all demographics and regions in the U.S., suicide prevention is one of the most challenging public health issues in recent history. Because of its prevalence, the number of federal agencies and national organizations involved with suicide prevention activities is at an all-time high (Office of the Surgeon General & National Action Alliance for Suicide Prevention, 2012). Instituted in 2001, the National Strategy for Suicide Prevention (NSSP) was revised in 2012 and serves as a guide for states in the fight against suicide through its strategies, goals, and objectives (Office of the Surgeon General & National …

Social Inclusion For Women Experiencing Homelessness, Jenna Richards

Electronic Thesis and Dissertation Repository

Background: People experiencing homelessness have been described as one of the most socially excluded groups in society due to their inequitable access to basic necessities (Everett 2009; Labonte, 2004). Particular consideration regarding social inclusion should be given to the unique vulnerabilities of sub-populations of those experiencing homelessness, such as women (Wesely & Wright, 2005) due to their increased rates of ‘hidden homelessness’ (Walsh et al., 2009) and experiences of violence and discrimination (Roschelle, 2017; Weiser et al., 2009). Community participation, particularly sports activities, have been cited as one method towards increasing social inclusion among people experiencing homelessness. However, differential access …

Assessing The Effectiveness Of A Quality Improvement Intervention To Decrease Missed Opportunities For Human Papillomavirus Vaccination At A Nurse Managed Health Center, Maria Medina-Calvo

Doctor of Nursing Practice

Purpose: To decrease the number of missed opportunities for human papillomavirus vaccine eligible patients seeking healthcare in a Nurse Managed Health Center. Background & Significance: Human papillomavirus genital infection has inflicted nearly 79 million Americans. Annually, about 14 million newly infected individuals are identified, with noted predominance in teens and young adults, and of this number approximately 19,200 females and 11,600 males receive a cancer diagnosis as a result of the human papillomavirus infection. The incidence of infections can be reduced with a human papillomavirus vaccine, but only about 63% of females and even fewer males initiate the human papillomavirus …

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

Building Shared Values In The Community: Culture Of Health, Donnelle D. Storrs

Doctor of Nursing Practice

The zip codes where patients live are stronger determinants of health outcomes than the frequency of visits with a primary care provider. Providers have a unique opportunity to extend health care beyond the clinic walls and engage in efforts to improve the communities where their patients grow, live, work, and age. In order to impact the health of patients, a culture of health needs to be developed. The Robert Wood Johnson Foundation culture of health action framework directed the build of a foundation of health as a shared value in a neighborhood with high morbidity and mortality rates in southwest …

Quality Improvement On Depression Protocols In The Military Training Environment, Priscilla R. Colunga

Doctor of Nursing Practice

Background: Active Duty military members are highly susceptible to depression and suicide due to separation from family during training and deployments, exposure to traumatic experiences in combat, and loss of friends during combat.

Purpose and Objectives: Depression and suicide remain a high priority among military personnel. This process improvement project aimed to improve the rate of depression screening and improve the assessment, treatment, and management of soldiers with depression in a primary care setting to prevent disease progression while waiting to be seen by a behavior health specialist.

Interventions: During the 6-week time frame, all active duty military and reservists …

Implementation Of The Human Papillomavirus Vaccine Among Health Professions Students, Emeka C. Nnabuife

Doctor of Nursing Practice

The human papillomavirus (HPV) is the most widespread sexually transmitted infection in America. College-aged students are a high-risk group for HPV transmission, but their HPV vaccination rates are low. The purpose of this evidence-based project was to implement an HPV vaccination program at a health science center university student health clinic to increase vaccination rates to meet the guidelines of the American College Health Association (ACHA) and the Centers for Disease Control and Prevention (CDC). The objectives of this project were as follows: 1) to educate providers and staff on the importance of the HPV vaccine; 2) to increase HPV …

Effects Of An Educational Intervention On Exclusive Breastfeeding Rates In Marshallese Mothers Residing In The U.S., Connor K. Otto

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Background: The largest population of Marshallese immigrants in the Contiguous U.S. resides in Northwest Arkansas. Despite adequate access to healthcare, the Marshallese face many health disparities, perhaps partly due to the language barrier they face in healthcare settings and education. Regarding breastfeeding rates, women in the Marshall Islands have a significantly higher rate of exclusive breastfeeding than in Marshallese women residing in the U.S. who face cultural barriers. Breastfeeding is positively correlated to many benefits for infants and is recommended exclusively for at least 6 months by pediatric policy organizations.

Objective: The purpose of this research is to examine breastfeeding …

Examining Eshift Through The Caregiver Policy Lens: A Content Analysis, Ashlee A. Worrall

Electronic Thesis and Dissertation Repository

Purpose: This research study intended to understand how a new model of palliative home care in Ontario, Canada called eShift aligned with the needs of caregivers who cared for a family member at the end-of-life.

Methods: A qualitative secondary analysis using a deductive content analysis of 14 caregiver interviews, three decision-maker interviews, and six home care agency documents collected in a three-year study and were analyzed using The Caregiver Policy Lens framework.

Findings: The eShift model of care met caregivers’ needs through timely access to respite, education, collaborating with the health care team, and physical and psychological support. Caregivers were …

Correctional Nurse Competency And Quality Care Outcomes, Deborah Shelton, Bill Barta, Louise A. Reagan

Journal for Evidence-based Practice in Correctional Health

Purpose: In this paper, we report on the clinical care outcomes resulting from implementing a nurse competency education intervention to a nursing staff in a statewide correctional system. Background: State correctional healthcare systems face ongoing and serious challenges attracting and retaining an adequate number of qualified health professionals owing to the perceived undesirability of working in correctional facilities; high occupational stressors; and the effects of high turnover on the workloads of remaining nursing staff.

Methods: Nursing outcomes were evaluated on four most frequently used nursing protocols. The education intervention consisted of self-directed computer-based modules, hands-on clinical review of skills, and …

Addressing Barriers To Abnormal Pap-Test Follow-Up Among Low-Income, Ethnic Minority Women: An Integrative Literature Review, Emme Deamont

Grace Peterson Nursing Research Colloquium

No abstract provided.

Nurse Practitioner Students: Providing Wellness Screenings To Underserved Older Adults, Rexanna Tatlock

Purdue Journal of Service-Learning and International Engagement

Rexanna Tatlock (BSN, RN, CCRN) received a BSN from Saint Francis College in 2003. As a registered nurse, she specialized in critical care nursing and eventually enrolled in the Adult Gerontology Nurse Practitioner master’s program in Purdue University’s School of Nursing in 2016. Upon graduation in May 2018, Rexanna has planned to focus on primary health care. The service-learning project provided primary care clinical experience, while meeting the needs of an underserved older adult population. This article will discuss the community partnership, a needs assessment, and a wellness screening offered to Fairington Apartments (FA) residents.

Faith Community Nursing In Community/Public Health Education: A Positive Student Nursing Experience, Pamela Preston

International Journal of Faith Community Nursing

Faith Community Nursing sites were recently integrated into a Community/Public Health Nursing course at a traditional Catholic baccalaureate college in New England. Junior and senior nursing students were randomly assigned to spend 10 clinical days at a site for their clinical experience. The students planned, participated in, and conducted diverse nursing and educational activities. At the end of the rotation, students completed evaluations rating the experience. The evaluations indicated that the clinical experience was positive. The diverse activities including support, health promotion, screening, and education in addition to the spiritual dimension allowed the students to participate in true holistic nursing …

Native Elder And Youth Perspectives On Mental Well-Being, The Value Of The Horse, And Navigating Two Worlds, Mary J. Isaacson, Rebecca Bott-Knutson, Mary Beth Fishbeck, Angela Varnum, Shelly Brandenburger

College of Nursing Faculty Publications

Purpose: Native American youth experience significant challenges to mental well-being. As part of a larger study to evaluate hope and resilience in a Plains tribal population, the purpose of this study was to learn from Native American elders and youths what they feel is needed to for youth to grow up healthy on the reservation, and to identify connections between horse use and mental well-being.
Sample: Six Native American elders and eight Native American youths from the same Plains tribe.
Method: The research team conducted Talking Circles with youths and elders. during the Talking Circles, participants identified community-specific questions for …

Querying Rural Content Experts Using An Online Questionnaire, Marilyn A. Swan, Barbara B. Hobbs

College of Nursing Faculty Publications

Purpose: Obtaining feedback from rural content experts is critical in developing valid and reliable instruments to advance the science of rural health. However, traditional methods, i.e., focus groups are impractical due to location and distance. Using an online questionnaire combined with telephone and email contacts to obtain content experts’ feedback is discussed. Item statement analysis and efficiency and effectiveness of the process are presented.
Methods: The process included the development of an online questionnaire, asking experts to rate 51 item statement for their relevancy, sufficiency of description, and clarity and readability. To increase the response rate, a series of four …

Exploring Men Who Have Sex With Men’S Hiv Pre-Exposure Prophylaxis Initiation Decision-Making Processes In The Southern United States, Portia Thomas

Doctorate of Nursing Science Dissertations

In 2012, the first pharmacological HIV preventative agent, pre-exposure prophylaxis (PrEP) was approved in the U.S. for individuals at high-risk of contracting HIV. Men who have sex with men (MSM) are at increased HIV risk, due to their engagement in anal intercourse (AI), which is the most common mode of HIV transmission and the riskiest type of sex. Although evidence indicates that most PrEP paients are MSM, a paucity of evidence exists on MSM’s PrEP initation decision-making process. The purpose of this study was to explore how HIV-negative MSM engaging in protected or unprotected AI decide to initiate PrEP based …

Using Motivational Interviewing To Increase Walking And Functional Ability In Older Adults: A Quasi-Experimental Study, Erin Lamoureux

Doctoral Dissertations

The purpose of this study was to determine if brief motivational interviewing (MI) sessions would increase daily steps and functional ability in older adults. Regular exercise in the older adult can slow the physical, psychological, and functional decline that is often associated with aging. However, only 25% of adults aged 65 and older meet the suggested physical activity recommendations of the American Heart Association and the National Institute of Health. Understanding what may contribute to the initiation and adherence of exercise within the older adult population might identify interventions that would successfully increase physical activity. This study focused specifically on …

Women's Quality Of Life After Leaving An Abusive Relationship: The Effects Of Past And Ongoing Intimate Partner Violence, Mastery And Social Support, Diana Jaradat

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) is considered a major stressor that threatens the lives of women globally. Although qualitative research suggests that IPV has substantial negative effects on women’s quality of life, few quantitative studies have examined the quality of life of women who have experienced IPV due, in part, to the lack of an appropriate, brief measure of QOL. Consequently, little is known about the contextual process by which IPV experiences affect women’s quality of life (QOL) after leaving an abusive relationship. Mastery and social support are two important resources that women may use to deal with IPV but whether …

Caring In The Margins: A Scholarship Of Accompaniment For Advanced Transcultural Nursing Practice, Ruth C. Enestvedt, Kathleen M. Clark, Kaija Freborg, Joyce P. Miller, Cheryl J. Leuning, Deborah K. Shuhmacher, Kristin M. Mchale, Katherine A. Baumgartner, Susan L. Loushin

Faculty Authored Articles

Nurses must learn essential skills based in transcultural nursing to address issues of equity and social justice. The development of a model for nursing practice for an urban nurse-led drop-in center for individuals experiencing marginalization provides an opportunity for student nurses to learn transcultural nursing skills that shifts care from acknowledging the need of others to accompanying others on their health journey. The practice model provides the opportunity for undergraduate and graduate nursing students at Augsburg University to de-emphasize tasks and build relationships. Students learn to listen to others' stories and acknowledge their struggles in the margins. Four stages of …

Utilizing Home Health Services To Reduce High-Risk Readmissions: A Quality Improvement Project, Courtney Robare

Nursing and Health Professions Faculty Research and Publications

The Centers for Medicare and Medicaid (CMS), the Joint Commission (TJC), Institute for Healthcare Improvement (IHI), and the Agency for Healthcare Research and Quality (AHRQ) have all highlighted readmissions as an issue in healthcare that needs to be addressed. Many of these organizations have piloted programs which aim to decrease readmissions.

The MAP (Medication Focus, Access Assistance, and Provider Collaboration) program seeks to decrease the readmission rate of high-risk patients. Readmissions are costly and often lead to negative patient outcomes. To decrease cost to the hospital and avoid penalties from the Centers for Medicare and Medicaid (CMS), the MAP program …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

Using Theories And Models For Operationalization Of Patient Trust In Doctors In Chronic Disease Response In Low Income Africa: ‘Best Fit Approach’, Kahabi Isangula

School of Nursing & Midwifery, East Africa

Background: Recent evidence suggest that improved patient trust in doctors can facilitate their healthcare seeking, adherence and continuity with care. With the growing burden of chronic disease in low income Africa (LIA) characterized by challenges of poor patient healthcare seeking, non-adherence and poor continuity with care, trust forms an important entry point for addressing these challenges. However, the topic of trust has generally received weaker attention among researchers in LIA contexts. To date, there has been no attempts to generate a clear guide for theory-driven inquiries as a means of operationalization of trust as a public health lens for chronic …

Gender And Experiences Of Family Homelessness, Fawziah Almalki

Electronic Thesis and Dissertation Repository

BACKGROUND: Family homelessness is a growing issue in Canada. Families have been reported as the most rapidly increasing population of emergency shelter users. The purpose of this study was to understand the experiences of family homelessness in A mid-sized Canadian city and, in particular, the role that gender plays in these experiences.

METHODS: This project was a secondary analysis situated within a critical theoretical perspective. The data for this study, consisting of 4 focus groups, 36 family member participants interviews, and 10 shelter staff members interviews, was extracted from a primary study that focused on diversion from family homelessness. Qualitative …

Nutrition Education To Improve Health Outcomes In Community Dwelling Older Adults, Sara Giessinger

Master's Projects and Capstones

Abstract

The proportion of people age 60 and over is growing faster than other age group, and will double by 2050 from approximately 605 million to 2 billion worldwide, in addition to the 80 and over population quadrupling by the same time. Non-communicable diseases such as obesity, cancer, coronary heart and lung disease, diabetes, hypertension, insulin resistance, and hyperlipidemia,represent 63% of deaths annually worldwide. Due to the immense contact nurses have with clients, they play a key role in screening, referrals and education to guide this demographic to improved health outcomes through nutrition and physical activity interventions (Xiaoyue, Parker, Ferguson, …