Digital Commons Network^™

Reducing Obesity Rates Among Adults In A Primary Care Setting: An Evidence-Based Practice Project, Raxita Neupane

Doctor of Nursing Practice Final Manuscripts

Background: Over 60% of adults in the United States meet the criteria for being overweight or obese. The estimated obesity-related health care costs are as high as $147 billion per year. Despite the alarming health risks and increasing health care costs, the rates of screening and counseling for obesity in the primary care setting are merely 30%. This project outlines weight-management counseling strategies.

Purpose of Project: The purpose of the evidence-based practice project was to implement patient-tailored evidence-based nutritional assessment tools and intensive behavioral counseling. The ultimate goal was to reduce body mass index (BMI) among overweight and obese …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo

Doctor of Nursing Practice Final Manuscripts

Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.

Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.

Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …

Increasing Physical Activity In Children And Adolescents During The Covid-19 Pandemic, Alyssa Plisic

Doctor of Nursing Practice Final Manuscripts

Exercise benefits physical and mental health, prevents chronic disease, and improves overall quality of life. Most children and adolescents do not meet daily physical activity recommendations (Child and Adolescent Health Measurement Initiative, 2019). The COVID-19 pandemic created large barriers for engagement in exercise and further decreased levels of activity in this population (Dunton et al., 2020; Moore et al., 2020; Sekulic et al., 2020). This project evaluates the effects of the COVID-19 pandemic on physical activity in youth 8-17 years old. An exercise journal increased activity in all participants and promoted attention to daily activity. Overall activity and participation in …

Emergency Department Visits And Hospital Admissions For Adult Cancer Patients Post Outpatient Chemotherapy: Does The Oncology Nurse Navigator Make A Difference?, Sunny L. Stirling

Dissertations

Background: Cancer is the second leading cause of death in the United States and worldwide. Oncology related hospital visits account for over $88 billion annually; 35% of this cost is attributable to inpatient hospital stays even though most cancer treatments are given outpatient. The Centers for Medicare and Medicaid Services introduced the Chemotherapy Measure which tracks Emergency Department visits and hospitalization within 30 days of any outpatient chemotherapy treatment. The Oncology Nurse Navigator (ONN) has offered some benefit in cancer care, but its role in ED visits and hospital admissions is unknown for adult patients with cancer post outpatient …

Food Insecure Copd Patients And Healthcare Utilization: A Retrospective Study, Kristine Mendoza

Dissertations

Abstract

Purposes/Aims: Despite advances in the recognition and treatment of high-cost users of health care, the incidence of healthcare utilization remains high. Rates of hospital admissions and emergency room visits among chronic disease like COPD have become a targeted group for health management. COPD patients have multiple and complex health and social needs, but the impact of their unmet food needs is not well understood and warrants further investigation. The purpose of this study is to explore the relationships between COPD food insecure patients and healthcare utilization in San Diego County.

Background/Rationale: Government programs targeting patients with high healthcare costs …

The Associations Of Chronic Stress, Social Support, Health Behaviors And Metabolic Syndrome Among Hispanic Women, Edna Esquer

Dissertations

The Associations of Chronic Stress, Social Support, Health Behaviors and Metabolic Syndrome Among Hispanic Women

Background: Metabolic syndrome (MetS) prevalence is 25% among Mexican American women 30 – 49 years of age, compared to 22% among non-Hispanic Whites in the United States. Little is known about the additional contributions of chronic stress, social support and health behaviors to the development of MetS among this population.

Purpose: Describe the associations between chronic stress, social support, and health behaviors and the presence of MetS in Hispanic women living in an underserved community.

Methods: A retrospective cohort study design. The Adult Treatment Panel …

Motivational Interviewing And Frequent Follow-Up In A Pediatric Primary Care Setting To Improve Diet And Activity In Adolescents, Celeste Armenta, Kathy James

Doctor of Nursing Practice Final Manuscripts

Background: Adolescent obesity is a serious health concern with increased worldwide prevalence. Excess weight gain can affect adolescent’s physical and emotional health. The adolescent with excess weight can involve acute and chronic long-term health complications that continue into adulthood.

Methods: Health care providers screened for overweight and obese adolescents during annual physicals and follow-up visits. Thirty adolescents at the 85th - 95th percentile and above on the growth chart received a pre and post clinical-screening questionnaire for eating behaviors and exercise. Individualized education with parent involvement and motivational interviewing (MI) was implemented with monthly follow-ups for 4 months.

Findings: Data …

Obesity Prevention Toolkit To Combat Weight Gain Related To Sedentary Behavior And Dietary Habits In College Students: An Evidence-Based Project, Maria Amos, Martha Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Forty percent of the US population ages 20-39 are categorized as obese,

their BMI is over 30, and 35% of college age students are obese or overweight. Issues related to obesity cost the US $147 billion annually. Between 40%-50% of college students are reported to be inactive. Inactivity can lead to increased morbidity and mortality related to increased risks of cardiovascular disease, diabetes, hypertension, musculoskeletal issues, and depression. Providing dietary and physical activity education and access to nutritional information promotes behavior change in young adults.

Aims of Service Change: This evidence-based project proposal aims to provide a toolkit …

Preventing Central Line Associated Bloodstream Infections In An Adult Intensive Care Unit, Monica Shaw

Master's Projects and Capstones

Central line associated blood stream infections (CLABSI) are considered preventable healthcare acquired infections, and are associated with significantly increased morbidity, mortality, and length of hospital stay. The CLABSI rate in an inpatient unit is a meaningful metric in relation to the safety and quality of care in that microsystem. This quality improvement project examines the efficacy of a CLABSI prevention bundle in reducing CLABSI events and improving adherence to central line care policy within a medical surgical adult intensive care unit. The target areas the bundle aimed to improve were unit processes, awareness of CLABSI and central line policies, and …

It’S Their Lifeline: Preventing Central Line Associated Blood Stream Infection In An Adult Intensive Care Unit, Jacenda Lee Rangel

Master's Projects and Capstones

Problem description: Central line associated blood stream infection (CLABSI) is one of the deadliest types of hospital acquired infection and blood stream infection, raising patient mortality by 12-25% and accounting for 28,000 deaths annually in the United States. CLABSI also increases morbidity, length of stay, and costs hospitals an average of $48,000 per case. Effective measures for CLABSI prevention are needed for an adult intensive care unit (ICU) of an urban hospital to decrease the financial burden of CLABSI, improve quality of care, and prevent patient harm.

Setting: The microsystem of focus is a 36-bed high acuity ICU. Patients of …

Understanding Older Adults Living In Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received, Christopher Rogers

Seton Hall University Dissertations and Theses (ETDs)

Older adults with type 2 diabetes living in medically underserved areas (MUAs) have unique health and social needs that must be taken into consideration when supporting their type 2 diabetes treatment and management care. Effective treatment and management of type 2 diabetes for older adults living in MUAs requires incorporating the preferences, desires, needs, values, and goals of the person at the center of the care into his/her care plan. Shifting care to be conducive to the treatment and management goals and plans co-created with older adults living in MUAs based on their individual physical, psychological, social, and spiritual preferences, …

Eras Protocol For Lower Extremity Orthopedic Procedures, Tyler Mcdonald, Joshua Vaughn

Doctor of Nursing Practice Projects

The demand for total knee arthroplasty (TKA) and total hip arthroplasty (THA) will continue to rise as life expectancy increases. Coupling increased age with the increased prevalence of both obesity and osteoarthritis, the need for total joint arthroplasties is likely to increase (Oseka & Pecka, 2018). The frequency of arthroplasty procedures and the associated recovery period lead to heavy economic demands felt by most healthcare systems (Stowers et al., 2016). To address this burden, enhanced recovery after surgery (ERAS) protocols have been implemented at institutions and are designed to improve patient outcomes while simultaneously limiting cost and reducing readmission rates …

The Current State Of Nursing Education In The Context Of Covid-19, Kaitlyn Kelly

Nursing Capstones

The field of nursing education has undergone massive changes in the context of COVID-19. Healthcare systems shifted to take care of an influx of patients, personal protective equipment shortages arose, and fear of transmission of the virus contributed to many nursing programs quickly transitioning to online instruction. These quick shifts leave many questions about the quality of education nursing students are currently experiencing. Although data may not yet be available to examine the effects of COVID-19 on nursing education, much can be learned by reviewing relevant literature published since the pandemic’s onset. This literature review describes changes to nursing education …

Treatment Of Trichotillomania, Kelsey Schwehr

Nursing Capstones

No abstract provided.

Better Together? The Effects Of Shared Medical Appointments On Bmi In Obese Adults, Amanda Larson

Evidence-Based Practice Project Reports

The United States (U.S.) is amidst an obesity epidemic, with Indiana ranking as the 15th worst state (Institute of Medicine, 2012; United Health Foundations, 2020). Despite current management strategies, the obesity rate in both the U.S. and Indiana continues to rise (WHO, 2020). Therefore, obesity management must change. The purpose of this evidence-based practice (EBP) project was to determine if the addition of shared medical appointments (SMAs) consisting of informational group sessions by specialists and brief individualized meetings with the provider will result in greater reduction of weight and body mass index (BMI) compared to standard care alone in those …

Education Combined With Reminder Strategies To Improve Cervical Cancer Screening Rates, Christina E. Mclean

Evidence-Based Practice Project Reports

Cervical cancer is the second most common cancer among women worldwide and a leading cause of death in some countries (Jayasekara, 2020). Approximately 13,800 cases of cervical cancer were diagnosed in the U.S. last year, and about 4,290 women died (American Cancer Society [ACS], 2020). Regular cervical cancer screening (CCS) reduces morbidity and mortality, but screening rates are low in the U.S. and at the project site (ACS. 2020). The purpose of this evidence-based practice (EBP) project was to increase CCS at a Federally Qualified Health Center (FQHC) with six clinic locations in Northwest Indiana; the primary project site was …

Pediatric Health Literacy, Morgan E. Sapper, Grace G. Lloyd

Senior Honors Projects, 2020-current

Abstract

Background: Unless you are a healthcare provider or licensed healthcare professional, understanding the United States healthcare system and its accompanying medical jargon can be confusing and overwhelming to try to navigate. Even more difficult is comprehending what resources are available to specific populations and how to gain the most benefit from these offered resources. Limited health literacy skills have been identified as the largest barrier in identifying an individual’s health outcomes. Health affects every stage of life. The purpose of this paper is to analyze what health literacy implementations look like as well as the age and developmental stage …

Evaluation Of A Renewal Room For Nurses, Danica Lee, Courtney Batra, Megan Knutson

Doctor of Nursing Practice Projects: College of Nursing

Wellness is an emerging and prominent issue in recent years, and specifically has a heavy influence on healthcare institutions and their employees. Having an outlet for self-care is important in developing resilience to life’s challenges. A Renewal Room is one approach to encouraging resilience and mental health restoration. The purpose of this study is to evaluate the usability of a wellness room for nurses. Data were collected in the form of an electronic survey that examined the utility (does it do what users need) and usability of the Renewal Room by determining who uses the room, when it is used, …

Implementation Of A Nurse-Led Family Centered Engagement Intervention For Caregivers Of Extremely Premature Infants In The Neonatal Intensive Care Unit, Emily Keenan, Michaela L. Ranallo, Kathleen A. Walsh, Haley Chapko, Tiffany A. Moore

Doctor of Nursing Practice Projects: College of Nursing

Objective: The objective of this feasibility study was to examine the implementation and usefulness of an intervention for extremely premature infant (EPI) caregivers.

Results: One caregiver and five nurses provided feedback with a mean score of 4.4 out of 5 pertaining to helpfulness.

Conclusions: Implementation of the Caregiver’s Guide was feasible and was positively received by NICU nurses and caregivers. We recommend implementing a revised version of this tool based on nurse and caregiver feedback. The delivery of education should be divided between dayshift and nightshift nurses so that one nurse is not responsible for providing all the information. The …

Introduction Of Strong For Surgery Pre-Surgical Checklist For Elective Procedures​, Dylan Defauw

Doctor of Nursing Practice Projects

Nearly one-third of hospitalized patients experience preventable harm or adverse effects related to the care they received, often due to preventable surgical complications. Thorough preoperative assessment and management of risk factors can lessen this risk. The purpose of this quality improvement project was to increase knowledge and prepare staff for use of the preoperative tool Strong for Surgery (S4S) in a general surgery clinic in a rural hospital in southern Illinois. Support for each of the key components of the Strong for Surgery pre-surgical checklist was reviewed in the literature; these include nutrition, smoking cessation, glycemic control, medication management, safe …

Culturally Appropriate Health Education: Translation Of A Parturient Pain Relief Options Pamphlet Into French And Spanish, Francis Minor, Austin Cook

Doctor of Nursing Practice Projects

The rise of immigration worldwide introduces a diverse, multicultural population of patients seeking healthcare in the United States. Barriers to communication, both spoken language and culturally associated communication norms, limit immigrant women’s ability to seek, gain access, and follow through with perinatal care. In order to provide safe, effective, and culturally sensitive care, recognition of language and cultural differences of all individuals must be considered when providing patients with educational materials (Perera et al., 2012; Plumbaum et al., 2014). The aim of this project was to translate an existing pain relief options pamphlet into French and Spanish in order to …

The Importance Of Providing Multimodal Analgesia: A Literature Review Of Nonpharmacologic Pain Treatments, Miriam Swartzentruber

Senior Honors Theses

Pain is a central aspect of the human experience. While painful stimuli can be beneficial in alerting the brain to the fact that there is something wrong, left untreated, pain can cause devastating long-term effects on the individual, both physically and mentally. Pain has traditionally been either undertreated or managed solely using pharmacologic methods, with less thought given to the importance of supplementing therapy with nonpharmacologic interventions. By incorporating nonpharmacologic methods of pain management into nursing care, patients can be provided with holistic treatment that improves patient outcomes, decreases healthcare costs, avoids future complications, and improves overall quality of life.

The Effects Of Diabetes Education On Long-Term Complications, Sunny Lawrence

Doctor of Nursing Practice Scholarly Project

The purpose of the scholarly project is to: a) Evaluate if diabetes education can improve a patient’s overall condition; b) Measure the chances of reducing long-term complications if a person is to participate in diabetes education and continue to follow up; c) Demonstrate that with effective diabetes self-management education (DSME) hemoglobin A1c can be reduced. The project design and target population were selected based on research performed on diabetes and diabetes education and the effects that it has on improving self-management in turn creating better glycemic control and fewer complications. This study will focus on type 2 diabetes, which is …

Education For Healthcare Providers, Nurses, And The Public On Opioid Induced Hyperalgesia, Jenny Greene

Doctor of Nursing Practice Scholarly Project

This project evaluated the knowledge of the public, healthcare providers, and nurses regarding opioid induced hyperalgesia (OIH). OIH is an elevated pain response because of high dosage or chronic use of opioids. Opioids are a problem not only in the United States but throughout the world; addiction, constipation, and overdose are the most frequently mentioned consequences of opioids. Little is known about other consequences to the body caused by chronic or high dose opioid usage, such as OIH. This project sought to increase awareness and caution against the utilization of opioids by patients and their healthcare providers and nurses practice. …

A Quality Improvement Initiative To Decrease Fall Risk In Community Dwelling Elderly, Michele Shearer

Doctor of Nursing Practice (DNP) Manuscripts

Falls are a health concern for the elderly and are the leading cause of fatal and non-fatal fall injuries in this population (Burns & Lee, 2016). Meijers, et al. (2012) found that one in three community dwelling elderly will experience at least one fall per year with an even higher rate in adults greater than 80 years old. Numbers of falls are expected to increase as this population ages. This increase in falls and their consequences will produce an enormous economic burden on the United States health care system (Burns & Lee, 2016). The purpose of this program was to …

Care Of The Healthcare Provider, Kari Hullinger, Emily Moscardelli

Doctor of Nursing Practice Projects

Evidence has shown a strong correlation between a healthy provider and the positive care that the provider can promote to others. Many evidence-based health promotion programs have been implemented throughout many health systems. These programs have shown improvement of the providers’ overall health. And in return, these providers are able to better care for their patients. Detailed reports have shown many health consequences that healthcare providers have acquired due to long hours, intense training, lack of time, lack of sleep, and the concept of always putting their patients first. A health system in Springfield, Illinois was examined to determine if …

Implementing An Evidence-Based Multifactorial, Multidisciplinary Fall Prevention Program In A Nursing And Rehabilitation Center To Reduce Fall Rates Among Patients, Tincy Poovathur

Doctor of Nursing Practice Projects

Falls are the leading cause of morbidity and mortality in the elderly in the United States. Patients in long-term care facilities are at increased risk for falls, accounting for 20 percent of fatal falls that require hospitalization. The economic and social burden of falls and fall-related injuries is significant. Fall-related injuries and their resulting expenditures are expected to increase substantially with the increasing aging population making this a problem of high priority. The literature recommends and supports incorporating evidence-based fall prevention initiatives into long-term care facility safety programs to address this problem. Based on the literature review and the facility's …

Presurgical Optimization Videos For Patients Undergoing Elective Spine Surgery, Megan Knetzer

Doctor of Nursing Practice Projects

Spine surgery is a growing healthcare trend with more than 199,000 lumbar fusions alone being performed in the United States in 2015 and annual costs of more than $10 billion. Spine surgery represents a major life-altering event for patients, with high complication rates and extensive recovery periods for which patients often feel unprepared. Presurgical optimization and education have the potential to decrease medical complications, improve outcomes, and reduce patient anxiety related to surgery. The purpose of this project was to implement presurgical education videos focused on modifiable risk factors for patients undergoing spinal surgery at an urban academic medical center. …

Physical Well-Being And Healthy Lifestyle Options, Michael Perkins

Doctor of Nursing Practice Projects

Background

The AANA has identified stress management or wellness as a priority for all CRNA programs. The Health and Wellness Initiative put in place by the AANA in 2004 is a model designed for all SRNA programs and intended to address students’ participation in wellness events in order to combat stressors.

The primary purpose of this project was to gain information about the stress faced by SRNAs enrolled at a Midwestern University and to evaluate strategies that could help students properly deal with stress.

Methods and Evaluation

Fifty-five students participated in the survey, data were compared by year in the …