The Association Of Lower Medication Adherence And Increased Medical Spending, Ryan A. Fuchs

Capstone

Medical prescribing is a common occurrence in daily clinical practice. According to the Centers for Disease Control and Prevention, in 2015-2016 45.8% of the U.S. population used prescription drugs in the past 30 days. (CDC, 2019) Although drug therapy can be effective in treating disease, full benefits are often not realized because many patients do not take their medications as prescribed. There is quite a bit of research out there about non-adherence to medication. Some studies focus on the financial impacts of non-adherence, but most of the studies examine the reasons for medication non-adherence. A gap exists in ...

How Is Health Seeking Behavior And Patient Outcomes For Latin Immigrants Affected By Language Barriers, Socioeconomic Status And Health Literacy?, Cassandra Sanchez

Nursing | Senior Theses

Background

Language barriers cause a disconnect between patients and health care workers. What further causes a disconnect is when patients have a lower level of education in addition to having a language barrier. I will be focusing on Latin immigrant individuals in the United States for my research. Many Latin immigrant patients may not have gone to school in their native countries, so their education level is lower making it harder to understand discharge information or patient teaching. When patients are unable to have that health literacy it may lead to negative patient outcomes due to not adhering to medication ...

Implementation Of Nola Pender’S “Clinical Assessment For Health Promotion Plan” To Increase Patient Self-Efficacy, Weight Loss And Health Promoting Behaviors Such As Improving Nutrition And Increased Physical Activity In Obese Women In A Weight Loss Clinic, Christine Ngwazini

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to review research-based studies on Nola Pender’s Health Promotion Model for weight loss and implement the evidence. The goal was to increase patient self-efficacy, weight-loss, and health promoting behaviors such as improved nutrition and increased physical activity among obese women in a weight loss clinic.

Background: Obesity leads to an increased risk of heart disease, stroke, type 2 diabetes, cancer, and premature death (CDC, 2020). From 2016 to 2017, 42.4% of people in the United States were obese (2020). Worldwide, over 650 million people ...

Utilization Of A Drug Use Screening Assessment: A Quantitative Study To Reduce Benzodiazepines In Inpatient Detoxification, Malerie Lazar Bolinsky, Mary Johnson, Sarah Devault

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

The use of benzodiazepines in the inpatient psychiatric setting is common for patients undergoing drug and alcohol detoxification but does not come without risks. Too high of a dose of benzodiazepines are often administered during detoxification when patients are not adequately assessed on admission. Current literature supports utilization of a screening tool for drug use can reduce unnecessary benzodiazepine use. This study implemented the Drug Use Screening Tool in a drug and alcohol detoxification unit of inpatient psychiatric hospital to evaluate severity of drug use on admission and established a statistically significant reduction in the use of as-needed benzodiazepines prescribe.

The Implementation Of An Evidence-Based Intervention To Increase Physical Activity In Overweight And Obese Children, Mollie Katherine Dowland

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background: Childhood obesity is an expanding issue of social and medical concern that requires a multidisciplinary approach for prevention and treatment (Ross et al., 2014). With 13.7 million children and adolescents in The United States considered overweight or obese, it is evident that change needs to transpire. Literature supports the use of behavioral incentives to increase a child’s physical activity, maintain or decrease weight, and improve body mass index (BMI) over time (Allafi, A., 2020; Finkelstein, E. et al., 2013; Groffik, D. et al, 2008; Staiano, A. et al., 2017).

Methods: This project executed change through the ...

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight ...

Increasing Advance Directive Rates In Primary Care: Implementation Of A Redesigned Form, Abbie Cheatham, Samereh Abdoli

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Less than half of individuals 65 and older have completed an advance directive despite evidence to their benefit. Lack of advance directives can have emotional and financial consequences for the family and individual. A major barrier to advance directive completion is the high literacy level most state sponsored forms are written at, with the average form written at a high school level. Methods: This quality improvement project was a three-month trial to increase the number of advance directive rates at a primary care clinic in the Knoxville area. Five Wishes, written at an 8th grade reading level was given ...

Overcoming Barriers To Implement Depression Screening Post-Stroke, Cameron Haeseker, Erin Morgan, Eric Wilson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background

One-third of all stroke survivors are expected to develop post-stroke depression, which is linked to lower quality of life, impaired recovery, increased risk of recurrence and an overall increase in mortality (Robinson & Jorge, 2015).

Objectives

Despite this link, outpatient clinics including the stroke clinic of focus do not consistently use a formal depression screen. Therefore, a pilot project utilizing the framework of the IOWA Model of Evidence Based Practice to implement this American Stroke Association recommended guideline may result in a permanent adoption of screening (Iowa Model Collaborative, 2017).

Purpose

The purpose of this evidence-based practice project was ...

Improving Patient Outcomes One Warm Patient At A Time, Lindsey King, Marcus Austin Robison, Julie Bonom Dnp, Michael Godbold Md

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Patient Temperature measurement postoperatively reveals that hypothermia occurs in surgical patients 25-90% of the time. Unintended perioperative hypothermia can be linked to many negative patient outcomes such as increased incidence of surgical site infection (SSI), delayed wound healing and increased length of hospital stay, to mention a few. Any single or combination of the aforementioned issues can eventually lead to an increase in patient morbidity and mortality. The purpose of this proposed quality practice improvement project is to increase the compliance of hypothermia prevention strategies, specifically forced air warming, at the implementation site. The targeted practice improvement is aimed at ...

Advancing The Care Continuum For The Homeless: A Shelter-Based Care Coordination Project Focused On Mental Health, Alexandra H. Sain, Allyson Neal Dr, Deborah Nichols Mrs.

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Advances in the care continuum are crucial for those with serious mental illness, especially those homeless individuals in the community. Schizophrenia is a leading cause of re-hospitalization and disability, accounting for billions of dollars spent in the United States. A prominent city shelter reports the prevalence of schizophrenia among its guests, and the community recognizes homeless shelters as the greatest source of 911 calls with countless surrounding emergency department visits. This project’s purpose is to implement a shelter-based, internal process to identify these high-risk guests and increase their subsequent care coordination services. Outcomes reflect individual benefits with increased shelter-based ...

Effect Of Implementing Admission History Optimization On Perceived Nurse Documentation Burden, Chelsea Smith Hardin, Mary Johnson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Electronic health records (EHR) and computer-based documentation is a powerful tool which has been adopted extensively in the last twenty years. The effect of EHR integration on staff has not been well studied, especially among nurses.

Purpose

The purpose is to investigate how optimization of nursing documentation effects the burden of documentation on nurses.

Methods

This project evaluated the admission history documentation at a community hospital that used essential data sets (EDS) to optimize the documentation process for nursing. To evaluate the documentation burden, the Burden of Documentation for Nurses and Midwives (BurDoNsaM) survey will be used before implementation ...

Anesthesia-To-Post Anesthesia Care Unit Handoff Standardization, Cassie Lee Bivens, Mark Timothy Cresap, Steven Michael Halcomb, Maureen Essie Taylor

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

The exchange of medical information from one medical professional to another is known as the handoff. Communication errors during the transition period of handoffs can lead to medication errors, delays in care, high stress within the work environment, and increased burnout of the nursing staff. Approximately 1,744 deaths and a total of $1.7 billion in malpractice costs were related to healthcare communication failures from 2012 to 2017. One of the areas of the hospital where effective handoffs are critically important, given the high frequency, is in the post-anesthesia care unit (PACU). Major organizations such as the Joint ...

The Development Of Evidence-Based Practice Mentors Through A Competency-Based Educational Program: A Leadership Perspective, Laura C. Moore, Tracy L. Brewer, Pamela Hardesty, Diana Burdick

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

One of the most productive strategies to achieving the safest, high-quality patient care is promoting the widespread use of evidence-based practice (EBP) in clinical settings. Despite the considerable emphasis and support for EBP, many clinicians still fail to translate current research into clinical practice. To address the pervasive lack of EBP among clinicians, an EBP project was developed at an acute care pediatric facility to increase EBP utilization via the implementation of a virtual EBP educational program. The findings from this project describe the establishment of an EBP educational program with the intent to create a critical mass of EBP ...

Quality Improvement: Education And Implementation Of Proper Narcotic Handling Practices By Nurse Anesthetists, Shelby Stevenson, Anne Hendershott, Alexis Asprah

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Medication errors are estimated to occur once in every 150-300 surgeries (Wahr et al., 2017, p. 36). Unsafe injection practices can lead to increased morbidity and mortality, diminish the overall quality of life for patients, and contribute to substantial increases in healthcare costs. A large majority of unsafe injection practices are caused by a lack of education or mistaken beliefs regarding safe injection practices. Educational reinforcement of safe narcotic handling techniques has significant potential to increase the appropriate use of narcotic syringes among nurse anesthesia providers. The long-standing impact of this project could lead to a reduced number of ‘never ...

Dexmedetomidine To Reduce Ponv, Amanda Johnson Srna, Joshua Lawrence Srna, Staci Martinez Srna, Taylor Mayberry Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative nausea and vomiting (PONV) contribute to patient dissatisfaction, discomfort, adverse outcomes, and increased healthcare costs. Despite current protocols that aim to reduce PONV by prevention/antiemetic administration, PONV continues to be a common manifestation in many postoperative patients (Elvir-Lazo et al., 2020). This scoping review aimed to analyze available research on the efficacy of dexmedetomidine to reduce perioperative opioid requirements and PONV.

Methods Synthesis of this scoping review began with a systematic approach to search databases and identify eligibility criteria articles. Of the 21 articles that met criteria, a synthesis table was formed to visualize the qualitative ...

Evaluation Of The University Of Nebraska Medical Center’S 4ms Geriatric Training Program At Nebraska Medicine Midtown, Holly M. Sesker

Capstone

In 2015, the Health Resources and Services Administration (HRSA) created the Geriatrics Workforce Enhancement Program (GWEP) to address geriatric workforce challenges and improve the health outcomes of older adults. The GWEP redefines care delivery through a movement for age-friendly healthcare guided by evidence-based practices that align with the 4Ms: What Matters, Medication, Mentation, and Mobility. The 4Ms identify the key issues that should drive the decision-making and care for every older adult. 4Ms training sessions were conducted at the Nebraska Medicine Midtown Clinic and evaluated through a cross-sectional survey administered to both residents (trainees) and attendings (trainers). Data was collected ...

Financial Outcomes By Severity Across Children's Hospitals, Jonathan Hartley

Research Days

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Background: Hospitalizations represent a significant driver of healthcare costs for children. Little is known about how payor type and the severity of children cared for on the pediatric medical inpatient floor impact a hospital’s financial outcomes.

Objectives/Goal: The primary objective of this study is to compare financial outcomes of pediatric hospitalizations to the medical inpatient floor across patient severity quartiles. Secondary objectives included financial outcomes stratified by payor type across severity quartiles.

Methods/Design: Retrospective cohort study included children aged 0-18 years discharged during calendar year 2019 from hospitals that reported clinical information ...

Primary Venous Thromboprophylaxis In Pediatric Oncology Patients, Kyra Mccarty

Research Days

Background: The Virchow’s Triad principles of venous stasis, endothelial damage, and hypercoagulability are all features of malignancy and contribute to the increased risk venous thromboembolism (VTE) seen in oncology patients. Additionally, certain chemotherapy treatments, presence of a central venous catheter and immobility are also intrinsically associated with malignancy diagnoses and exacerbate this risk. However, much debate exists over the use of thromboprophylaxis in the pediatric population, primarily due to lack of evidence regarding safety and efficacy, primarily the risk of major bleeding. Multiple retrospective studies have attempted to identify the primary risk factors for VTE in this pediatric oncology ...

Improving Transition To Adult Care Discussion In A Diabetes Clinic, Erica Wee, Erica Zarse, Lindsay Baldridge

Research Days

Problem Statement: Diabetes mellitus is a chronic condition requiring complex care. Adolescents with diabetes face challenges when transitioning to an adult care setting which can lead to suboptimal glycemic control and emergence of complications. It is important for a pediatric diabetes clinic to provide support and prepare adolescents for success when they transfer to adult care.

Aim Statement: In our diabetes clinic, patients are eligible for transition assessment if they are over age 17 years without a documented discussion in the past 1 year. A review of clinic data between October 2021 and November 2021 revealed that an average of ...

Development Of A Community Hospital Medicine Affiliated Inpatient Rotation For Family Medicine Residents - A Collaborative Success, David M. Gallagher, Anthony J. Viera, William E. Bynum, Poonam Sharma, John W. Ragsdale, Jeffrey Eschbach, Lalit Verma

Journal of Community Hospital Internal Medicine Perspectives

Background: Hospitalists perform key roles as inpatient educators for family medicine residents. For the past decade, Duke University Family Medicine Residency Program had its inpatient family medicine resident rotation at non-Duke facilities.

Objective: The authors describe the steps taken in 2020 to develop an inpatient Duke family medicine rotation at a North Carolina community hospital, Duke Regional Hospital, and provide outcomes data.

Methods: Duke Family Medicine Residency and Duke Regional Hospital Medicine collaborated in addressing key issues to develop an inpatient rotation for family medicine residents. Performance metrics of patients cared for by both the family medicine inpatient resident team ...

Esmolol Compared To Fentanyl On Hemodynamic Effects: A Scoping Review, Anna Mccleskey Bsn, Rn, Srna, Landon Mcdonald Msn, Rn, Cnl, Tim Moore Bsn, Rn, Srna, Jamie Pitcock Bsn, Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose The purpose of this DNP project is to compare the efficacy of esmolol to fentanyl in attenuation the hemodynamic response associated with direct laryngoscopy.

Specific Aims Compare the effects of esmolol to fentanyl on patient heart rate during laryngoscopy. Compare the effects of esmolol to fentanyl on patient mean arterial pressure during laryngoscopy.

Transferring Patients To A Higher Level Of Care, Chiquita Rockiemore Rn, Msn, Olubunmi Osinloye Bsn, Rn, Angela Uta Bsn, Rn, Tracy Mcclinton Dnp, Ag-Acnp-Bc

Doctor of Nursing Practice Projects

The purpose of this study is to determine whether the transfer of critically ill patients, who require a higher level of care, to another facility impacts morbidity and mortality within 24-72 hours post transfer

Monitoring Adherence To Hcv Screening Among The Baby Boomer Population, Sarah Miller Bsn, Rn, Autumn Spight Bsn, Rn, Mahogany Freeman Bsn, Rn, Sharon Little Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background Chronic hepatitis C is currently the most common cause of liver disease in the United States and is associated with various complications that increase mortality and morbidity, yet many people go unidentified and thus untreated. The CDC created guidelines in 2012 for hepatitis C screening and testing among the baby boomer population due to their high rates of HCV infection and HCV-related mortality. Our project aimed to assess the adherence of hepatitis C screening, based on these CDC guidelines, of individuals within the baby boomer population (1945-1965) in the primary care setting through retrospective chart review.

Methods A ...

Dexmedetomidine Vs. Propofol In Postoperative Delirium Prevention, Jaclyn Burnett Rn, Srna, Montana Betts Rn, Srna, Christhian De Ochoa Rn, Srna, Maciej Chec Rn, Srna, Dwayne Accardo Dnp, Crna, Aprn

Doctor of Nursing Practice Projects

Purpose/Background Postoperative delirium (POD) is an acute neurological condition affecting large numbers of surgical patients in various practice settings. Patients suffering from this condition face postoperative complications, increased lengths of stay, and tremendous financial burden. Understanding the contributing factors for POD, and how adjustments in intraoperative agents can prevent or reduce the incidence, is a crucial aspect of anesthesia practice. This scoping review will examine associations between POD and the intraoperative use of propofol versus dexmedetomidine with general anesthesia.

Methods Studies in this review were limited to peer-reviewed literature, published in medical and nursing journals within the last five ...

The Influence Of Dash Diet Education On Knowledge And Adherence In Primary Care: A Quality Improvement Project, Paige Bekker

Culminating Experience Projects

Background/Local Problem: A rural family practice was concerned about the number of

patients with uncontrolled hypertension, 19.86% n = 56, as defined by the Centers for Disease Control and Prevention (CDC). After several quality improvement (QI) initiates to lower the prevalence rate of uncontrolled hypertension, including proper measurement techniques and home monitoring, the modifiable risk factor of adapting one’s food intake was introduced using the Dietary Approach to Stop Hypertension (DASH) diet as an intervention. The DASH diet is an evidence-based approach for lowering blood pressure. The QI project was completed with the purpose of implementing DASH diet ...

Community Health Worker Intervention To Improve Hba1c In Adult Diabetic Patients, Megan Wojtko

Doctor of Nursing Practice Projects

Type 2 Diabetes Mellitus (T2DM) is a disease that disproportionally impacts patients with multiple socioeconomic barriers that are often difficult to address during a primary care visit. Several provider and practice-level barriers also exist including time limitations within the visit and lack of trained staff to help with patient education and case management. Uncontrolled T2DM leads to poor health outcomes and increased healthcare costs. Community Health Workers (CHW) are trained lay persons that can successfully address the patient’s unmet needs and assist with the provider’s recommendations. The purpose of this project was to explore if a CHW led ...

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 ...

Bedside Shift Report And Patient Satisfaction, Kasandra Johnson

Electronic Theses and Dissertations

Each year, millions of deaths worldwide are caused by medication errors in hospitals. Some of these errors are accounted for through miscommunication during the change of the nurse shift report. One of the Joint Commission’s 2019 national patient safety goals for hospital programs was to improve communication effectiveness among caregivers since mistakes in a caregiver’s communication accounted for 37% of severe patient injuries. Safety is threatened by patients not being included. Therefore, adopting the bedside shift report allows patients to be actively engaged, reinforcing nurse-patient communication. The bedside shift report enables nurses to provide safe, high-quality, patient-centered care ...

Civility And Communication Interventions To Improve Patient Outcomes, Lane Denney

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Communication in health care is vital for the successful care of patients and their outcomes while they are hospitalized. Healthcare workers are responsible for communicating patient information whether it is between change of shifts or reporting to a patient’s provider. It is important that this information is communicated effectively. This review evaluates how nurses communicate in shift- report and how this affects patient outcomes and civility between nursing units and teams. Overall, bedside shift reports promoted the best patient outcomes and increased teamwork on hospital units.

A Quantitative Job Satisfaction Comparison Between Certified Nursing Assistants (Cnas) Providing Care In Patients’ Homes Versus In Long-Term Care (Ltc) Facilities In The Omaha Metropolitan Area, Rusheena Shah

Capstone Experience

This capstone project looks at overall job satisfaction comparison between two groups of Certified Nursing Assistants (CNAs) – CNAs who provide home care in patients’ homes and CNAs who provide care in Long-term Care (LTC) facilities in the Omaha Metropolitan Area. In this quantitative study, a survey was sent to CNAs who provide home care to patients and CNAs who provide patient care at different nursing home facilities in the Omaha area. Prior research has indicated that even though CNAs perform similar job duties irrespective of the work environment; they experience varying degrees of job satisfaction which could be attributed to ...