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- Depression (3)
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- Adolescents (2)
- Chronic pain (2)
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- Palliative care (2)
- Primary Care (2)
- Primary care (2)
- Readmissions (2)
- Self-care (2)
- Veterans (2)
- ADHD (1)
- ATP degradation (1)
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- Acute care (1)
- Allantoin (oxidative stress) Abdominal Near-Infrared spectroscopy (1)
- Aromatherapy (1)
- Bariatric Surgery (1)
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- Binge eating (1)
- Binge eating disorder (1)
- Binge eating disorder treatment (1)
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- Cardio-metabolic syndrome (1)
- Case Study (1)
- Childhood obesity (1)
- Children (1)
- Chronic low back pain (1)
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Articles 1 - 28 of 28
Full-Text Articles in Medicine and Health Sciences
Evidence-Based Strategies For Reducing Post-Discharge Hospital E.R. Visits And Patient Initiated Calls In The Post Craniotomy Population, Homira Feely
Doctor of Nursing Practice Final Manuscripts
Evidence-based Strategies for Reducing Post-discharge E.R. Visits and Patient Initiated Calls in the post Craniotomy Population
Homira Feely, NP
Katherine Curran, BSN
Joseph Burkard, DNSc, CRNA
University of San Diego
OBJECTIVE
Health-care professionals are generally compassionate and well-meaning, but the infrastructure in which they function often has made the continuum of care between hospitals, outpatient settings and patients’ homes far from seamless. The result is a persistently high rate of emergency room visits and hospital readmissions within 30 days of a patient’s discharge – an avoidable pattern that has cost the U.S. health system tens of billions of dollars over …
Bariatric Surgery Regain And Long-Term Weight Loss Among Women: Self-Efficacy, Social Support And Health Promotion Lifestyle Behaviors, Raelene Z. Brooks
Bariatric Surgery Regain And Long-Term Weight Loss Among Women: Self-Efficacy, Social Support And Health Promotion Lifestyle Behaviors, Raelene Z. Brooks
Dissertations
Although bariatric surgery appears to produce success in a short period of time immediately after surgery, weight regain over time in this population cannot be ignored. Understanding the relationship between potential psychosocial predicting post-surgical variables influencing bariatric surgery may prevent long-term weight regain. The purpose of this research is to examine self-efficacy, social support, and lifestyle habits and their relationship to long term weight loss and regain in women post bariatric surgery. Weight regain is observed as early as 18 months to 2 years after bariatric surgery. Patients face challenges sustaining the dramatic lifestyle changes required to ensure positive long-term …
Management Of Chronic Low Back Pain With A Nonpharmacological Pain Management Kit Among Military Personnel, Heidi M. Sterling Bsn, Rn, Dnp Student, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Robert Topp Phd, Rn
Management Of Chronic Low Back Pain With A Nonpharmacological Pain Management Kit Among Military Personnel, Heidi M. Sterling Bsn, Rn, Dnp Student, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Robert Topp Phd, Rn
Doctor of Nursing Practice Final Manuscripts
Background & Purpose:Low back pain is the second leading cause of disability in the United States, affecting 17% of Americans. Chronic low back pain (CLBP) is particularly debilitating among professions such as active duty military personnel (ADMP) who are required to maintain military readiness without the assistance of opioids. This scenario can result in individuals enduring untreated pain or resigning from participation in their unit. The purpose of this project is to determine the effect of providing a nonpharmacological pain management kit (NPMK) on pain and functional ability among ADMP who report CLBP.
Study Design:ADMP who suffer from CLBP were …
Optimizing Chronic Pain Management: Self-Care Utilization Among Veterans With Post-Traumatic Stress Disorder, Paul Krug, Anamarie J. Lazo, Joseph Burkard, David Bittleman
Optimizing Chronic Pain Management: Self-Care Utilization Among Veterans With Post-Traumatic Stress Disorder, Paul Krug, Anamarie J. Lazo, Joseph Burkard, David Bittleman
Doctor of Nursing Practice Final Manuscripts
Purpose: To implement a chronic pain management regimen that utilizes a self-care approach, integrating all dimensions of the biopsychosocial model to optimally treat the complex needs of younger Veterans with comorbid PTSD and chronic pain. The project aims to provide more insight and knowledge on safer chronic pain management among Veterans, reflected by improvement in patient’s pain level, quality of life, and depression scale.
Design: The project was implemented at the ASPIRE Center, a domiciliary residential rehabilitation treatment program for Veterans who suffer from PTSD and traumatic brain injury. The 5A’s behavior change model was utilized during clinic …
Stop, Meditate, And Listen: A Treatment Modality For Iraqi Refugees With Depression, Katherine Goehring
Stop, Meditate, And Listen: A Treatment Modality For Iraqi Refugees With Depression, Katherine Goehring
Doctor of Nursing Practice Final Manuscripts
Purposes: To implement a mindfulness meditation program with Arabic speaking clients as an adjunctive treatment of depression
Background: Depression rates among Iraqi refugees are between 28.3 and 75% compared to 8.6% in the general population (Slewa-Younan, Guajardo, Heriseanu, & Hasan, 2015). Treatment options are limited at Neighborhood Healthcare in El Cajon due to budget limitations, cultural beliefs and language barriers, among other reasons. Individual therapy is intended to be a brief intervention due to limited staffing. Many middle eastern refugees decline group therapy due to stigma surrounding mental health treatment and concerns about privacy. Even though traditional treatment …
Screening For Binge Eating Disorder In Patients Undergoing A Weight Loss Program, Doris Cheruiyot
Screening For Binge Eating Disorder In Patients Undergoing A Weight Loss Program, Doris Cheruiyot
Doctor of Nursing Practice Final Manuscripts
Background: Binge eating disorder (BED) is the most common eating disorder in the United States, it is more prevalent than Anorexia Nervosa and Bulimia combined. BED is characterized by recurrent episodes of binge eating accompanied by feeling a lack of control and marked distress over one’s eating behaviors. BED is a serious condition that impairs health-related quality of life (HRQL) and increases health care costs.
Purpose: The purpose of this project was to identify patients at risk for binge eating disorder at an outpatient weight loss clinic using the validated BEDS-7 screening tool.
Evidence-based Intervention: The 7-item Binge-Eating Disorder Screener …
Improving Quality Of Life In Veterans With Chronic Pain Through Patient Engagement, Linda Nyagaya
Improving Quality Of Life In Veterans With Chronic Pain Through Patient Engagement, Linda Nyagaya
Doctor of Nursing Practice Final Manuscripts
Background: Various psychosocial factors affect follow up care among veterans with chronic pain. Engaging veterans by giving them the choice to decide contact modality for after clinic visit increases likelihood of successfully reaching patient and adherence to recommended pain management.
Purpose: To engage veterans through self-determined effective communication method: telephone, email or Myhealthevet for follow up care. The intervention aims to improve chronic pain self-care by assessing number of medications used for pain, numeric pain rating and quality of life score.
Framework/EBP Model: The Iowa Model and 5A’s will guide implementation and assessment of this project. Patients will self-determine the …
A Common Goal: Primary Care And Psychiatry Improve Depression Detection And Outcomes, Katherine Kilkenny
A Common Goal: Primary Care And Psychiatry Improve Depression Detection And Outcomes, Katherine Kilkenny
Doctor of Nursing Practice Final Manuscripts
Background: Major Depressive Disorder (MDD) affects over 15 million (6.7%) adult Americans. While one in four primary care patients suffer from depressive symptoms, MDD is accurately diagnosed as little as 25% of the time.
Purpose: Implementation of an evidence-based protocol outlining the process for screening, behavioral health referral, and the role of a collaborative care team would improve detection and treatment of adult MDD patients in the ambulatory setting.
Process: A systematic Patient Health Questionnaire (PHQ-9) based screening protocol was implemented. Every new and existing patient completed the PHQ-9 during scheduled primary care appointments. If a patient scored 15 or …
In Honor Of Self: A Weight Loss Project For A Military Population With Mental Disorders, Tanya Denise Stevenson-Gaines
In Honor Of Self: A Weight Loss Project For A Military Population With Mental Disorders, Tanya Denise Stevenson-Gaines
Doctor of Nursing Practice Final Manuscripts
Background: Obesity in people diagnosed with mental disorders is at an epidemic level. Individuals with a mental illness who are prescribed medication for stability are at risk for obesity and metabolic syndrome. People with mental disorders have a 10 to 30-year decrease in life expectancy associated with chronic illnesses. Military personnel are separated from service when they are measured outside of body composition assessment standards.
Aims: To address the problem of obesity in military members by providing a weight loss program with structured and collaborative weight management education and telephonic coaching.
Methods: Stakeholders were informed about the purpose and goals …
Focus On Fitness: Incorporating Exercise Into The Treatment Of Children And Adolescents With Attention-Deficit Hyperactivity Disorder, Kristin Lulich
Focus On Fitness: Incorporating Exercise Into The Treatment Of Children And Adolescents With Attention-Deficit Hyperactivity Disorder, Kristin Lulich
Doctor of Nursing Practice Final Manuscripts
Background: Psychotropic medications, particularly stimulants are frequently used as the first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD). Many patients and their caregivers have concerns about psychotropic options for treatment. Review of current literature demonstrates the efficacy of physical activity in reducing symptoms of ADHD. Purpose: This evidence based practice (EBP) project introduced regular, scheduled aerobic activity into the treatment plan of children and adolescents with ADHD. The aim of this EBP was to reduce symptoms of ADHD measured by caregivers using the Vanderbilt Ratings Scale. The Johns Hopkins Nursing Evidence Based Practice Model was used to implement this project. …
Prevention Of Functional Decline In Hospitalized Geriatric Patients: An Evidence-Based Mobility Pilot Project On An Acute Care Elderly (Ace) Unit, Hannah Grushkowsky
Prevention Of Functional Decline In Hospitalized Geriatric Patients: An Evidence-Based Mobility Pilot Project On An Acute Care Elderly (Ace) Unit, Hannah Grushkowsky
Doctor of Nursing Practice Final Manuscripts
Problem: Functional decline is the leading complication of hospitalization in the elderly. Loss of functional independence during hospitalization results from the inability to maintain function during hospitalization compounded by acute illness. Potential negative outcomes from decreased function include increased length of stay (LOS), morbidity, and added discharges to a skilled nursing facilities (SNF).
Introduction: A mobility-based protocol created by an interdisciplinary team was implemented for three months on an 8 to 12-bed specialized Acute Care Elderly (ACE) medical-surgical floor. The purpose of the project was to evaluate if an evidence-based practice (EBP) mobility protocol can decrease discharges to SNFs, falls, …
Family Nurse Practitioner Student Competencies In Integrated Psychiatric Healthcare, Mark Manning
Family Nurse Practitioner Student Competencies In Integrated Psychiatric Healthcare, Mark Manning
Doctor of Nursing Practice Final Manuscripts
Title: Practicum to Practice: Family Nurse Practitioner Student Competencies in Integrated Psychiatric Mental Healthcare.
Background: Major Depressive Disorder (MDD) is a widespread and costly diagnosis that affects nearly 16 million people annually and costs the United States nearly $83 Billion. Primary care providers such as Family Nurse Practitioners (FNP) play a crucial role in screening for health problems, preventing, and managing illness. Opportunities exist to integrate psychiatric mental healthcare into FNP curriculum and clinical practicums to better prepare providers to identify and screen for depression.
Purpose: The purpose of this evidenced-based practice project is to evaluate FNP student competencies …
The Effect Of Mantram Repetition On Qol In Low-Income, Urban Dwelling Older Adults, Marissa Katerina Mackiewicz
The Effect Of Mantram Repetition On Qol In Low-Income, Urban Dwelling Older Adults, Marissa Katerina Mackiewicz
Dissertations
Background: Quality of life is an important concept of increasing significance for the healthcare in the United States, especially when taken in perspective of the aging population. Low-income, urban dwelling older adults are challenged in a number of ways that may negatively impact their QOL. This unique group is prone to report lower QOL, therefore, interventions targeted to improve QOL are timely. The purpose of this study was to describe the effect of mantram repetition (MR) on QOL in a sample of low-income, urban dwelling older adults.
Methods: A quasi-experimental pre-posttest study was conducted using a sample population of low-income …
The Weight Of A Healthy Home: Early Screening For Childhood Obesity Risk, Sara Herbenick, Kathy James, Dnsc, Aprn, Faan, Jill Milton, Msn, Fnp
The Weight Of A Healthy Home: Early Screening For Childhood Obesity Risk, Sara Herbenick, Kathy James, Dnsc, Aprn, Faan, Jill Milton, Msn, Fnp
Doctor of Nursing Practice Final Manuscripts
Purpose
Despite the Healthy People 2020 target of 14.5%, the California obesity prevalence among low-income children ages 2 to 19 was 21% in 2010. An obesogenic home environment is a major contributor to overeating and sedentariness during this phase of development as children have less autonomy and are influenced by family environmental cues. The purpose of this evidence-based project was to implement a screening tool at a low socioeconomic elementary school clinic to identify children at risk of developing obesity and provide standardization for practitioners on educating parents regarding child obesity risk factors. The Family Nutrition and Physical Activity (FNPA) …
What’S Keeping America’S Heroes Awake? Screening For Obstructive Sleep Apnea In Male Veterans With Hypertension And Diabetes, Aaron James Stirling
What’S Keeping America’S Heroes Awake? Screening For Obstructive Sleep Apnea In Male Veterans With Hypertension And Diabetes, Aaron James Stirling
Doctor of Nursing Practice Final Manuscripts
Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM).
Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to …
Diabetes Self Management Education In An Underserved Primary Care Setting, Jessica Salas
Diabetes Self Management Education In An Underserved Primary Care Setting, Jessica Salas
Doctor of Nursing Practice Final Manuscripts
Objective: A key component to the management of type 2 diabetes is appropriate self management of the disease by the patient. The purpose of this project was to provide culturally appropriate Diabetes Self Management Education in an underserved primary care setting to improve glycemic control among Spanish speaking patients who have uncontrolled diabetes.
Research Design and Methods: The evidence based practice project took place at a primary care practice in an underserved area. Fifteen Spanish speaking patients with uncontrolled type 2 diabetes with a hemoglobin A1c greater than 7% were included in the intervention. The intervention included implementation of Diabetes …
Power To The Patients: A Heart Failure Transitions Of Care Program In A Heart Resource Center, Katherine Nicole Oxina Padiernos Bsn, Rn, Dnp Student, Scot Nolan Dnp, Rn, Cns, Ccrn, Teri Armour -Burton Phd, Cnml, Ne-Bc, Colleen Austel Nadeau Bsn, Rn, Chfn
Power To The Patients: A Heart Failure Transitions Of Care Program In A Heart Resource Center, Katherine Nicole Oxina Padiernos Bsn, Rn, Dnp Student, Scot Nolan Dnp, Rn, Cns, Ccrn, Teri Armour -Burton Phd, Cnml, Ne-Bc, Colleen Austel Nadeau Bsn, Rn, Chfn
Doctor of Nursing Practice Final Manuscripts
Background: In the United States an estimated 5.7 million adults have heart failure (HF), costing $30.7 billion annually. National HF readmission rates have remained high at 21.3%. After an extensive literature review, the purpose of this project was to incorporate teach back methods, self care education, resource accessibility, and increased post-discharge contact through an outpatient heart failure transitions of care program.
Methods and Results: Prior to discharge, HF patients were recruited and given a pre-test Self Care of Heart Failure Index (SCHFI). A DNP student and progressive care unit registered nurses provided discharge education utilizing a Healthy Heart Tracker booklet …
Identification Of Nurse-Controlled Predictors Of Pain In Patients Undergoing A Total Hip Or Total Knee Arthroplasty, Melodie Ruth Daniels
Identification Of Nurse-Controlled Predictors Of Pain In Patients Undergoing A Total Hip Or Total Knee Arthroplasty, Melodie Ruth Daniels
Dissertations
Objectives: The purpose of this study was to examine relationships among nursing interventions and pain status during hospitalization in orthopedic surgical patients receiving total hip or knee arthroplasty in one of four community hospitals in San Diego, California.
Background: The epidemic of opioid-related adverse events creates a need for opioid sparing approaches to pain management. Pain management practices have been studied in relation to medicine; however, the relationship between pain and opioid sparing, nurse-specific interventions is not clear.
Methods: The retrospective descriptive study examined Electronic Health Record (EHR) data of patients (N = 1657) discharged after a total hip …
Priapism Among Male Adolescents With Sickle Cell Disease, Prince Ocansey
Priapism Among Male Adolescents With Sickle Cell Disease, Prince Ocansey
Dissertations
The purpose of this qualitative phenomenological study was to describe the lived experience of priapism among male adolescents with sickle cell disease (SCD). A painful genetic disorder with no cure, SCD severely impacts the lives of patients, as well as their families and friends. Priapism is one of the complications of SCD and involves persistent and painful penile erections. The review of literature established a gap in researchers’ understanding of the lived experience of priapism among male adolescents with SCD. This study aimed to bridge that gap.
Using a convenience sampling method, 7 adolescent males between the ages of 16 …
The Association Of Kangaroo Mother Care, Energy Conservation, And Bonding In Preterm Neonates, Dorothy Forde
The Association Of Kangaroo Mother Care, Energy Conservation, And Bonding In Preterm Neonates, Dorothy Forde
Dissertations
Purpose:To examine the association of kangaroo mother care (KMC) on energy utilization and bonding as evidenced by reduced biochemical markers of adenosine triphosphate (ATP) degradation, hypoxanthine (Hx), xanthine (Xa), and uric acid (UA), and (allantoin), a measure of oxidative stress in preterm infants 24-36 weeks gestation. A secondary objective was to compare specific physiological parameters using bedside monitoring and perfusion and oxygenation of the gut using near-infrared spectroscopy (NIRS) during 1 hour of KMC compared to incubator care.
Study design: A randomized controlled trial (RCT) examining the effects of 1-hour of KMC or 1-hour incubator care on urinary markers …
Examining The Relationships Between Ethnicity, Palliative Care And Readmissions In The Heart Failure Population, Deanna Johnston
Examining The Relationships Between Ethnicity, Palliative Care And Readmissions In The Heart Failure Population, Deanna Johnston
Dissertations
Specific Aim: The aim of this dissertation is to analyze the relationships between ethnicity, palliative care consultation and readmissions in the heart failure population at a community hospital that serves a large diverse population.
Background: Hospitals struggle with preventing readmissions. There are many interventions that can be implemented to help prevent readmissions, and Palliative Care (PC) is one of those interventions. PC has many benefits including symptom management, improved communication through the healthcare continuum, understanding of illness and treatment options, and can be provided in conjunction with curative treatments. Heart failure is one of the most common readmission diagnoses. …
Metabolic Syndrome Screening Among Inpatient Psychiatric Patients, Susan Magorno
Metabolic Syndrome Screening Among Inpatient Psychiatric Patients, Susan Magorno
Doctor of Nursing Practice Final Manuscripts
Background: More than 50% of patients with severe mental illness carry undiagnosed Metabolic Syndrome (MetS) comorbidities of hypertension, hyperlipidemia, or diabetes. These patients are three times more likely to die of cardiovascular-related causes; however, this population is not routinely assessed for MetS and frequently lack appropriate treatment.
Objective: The objective is to implement a screening tool designed to identify risk for MetS and trigger appropriate treatment.
Design: The screening tool triggers the provider to address positive criteria through interventions such as further evaluation, medical and/or diabetes educator consultation.
Results: Although overall rates of screening improved significantly, follow-up interventions were …
Increasing Follow-Up In College Students With Latent Tuberculosis Infection, Emily Middleton, Dnp, Aprn, Ccrn, Kathy James, Dnsc, Aprn, Faan, Kimberly Woodruff, Md, Mph
Increasing Follow-Up In College Students With Latent Tuberculosis Infection, Emily Middleton, Dnp, Aprn, Ccrn, Kathy James, Dnsc, Aprn, Faan, Kimberly Woodruff, Md, Mph
Doctor of Nursing Practice Final Manuscripts
Around 13 million people in the United States have latent tuberculosis infection (LTBI) with a 5-10% chance of developing active tuberculosis (TB) in their lifetime if not treated (Center for Disease Control, 2015). At a University Student Health Center (SHC), there is a matriculation requirement for TB testing for students that screen as high risk. Many students have these testing requirements performed at outside clinics, including foreign clinics, and follow-up regarding education about LTBI and treatment recommendations was often missing. The purpose of this evidence-based practice (EBP) project was to increase follow-up, education, and treatment options after diagnosis of LTBI. …
Oxygen Consumption In Sepsis, Julie Graham
Oxygen Consumption In Sepsis, Julie Graham
Dissertations
Background: Sepsis is a life-threatening condition that can lead to septic shock and death. With over 300,000 annual cases (AHRQ, 2011) costing a staggering $1.5 billion (Health Care Utilization Project Brief #185), the importance of sepsis is becoming clear. However, some basic biological mechanisms are poorly understood. Study Purpose: This study investigated the relationships between select demographics, resting energy expenditure (REE), serum lactate, SOFA score mortality index, oxygen consumption [by way of measuring net oxygen consumed, (V02) and net carbon dioxide produced (VC02)], and sepsis. Specific Aims: Aims were to describe 1) patient demographics, serum lactate, SOFA score mortality index, …
Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio
Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio
Doctor of Nursing Practice Final Manuscripts
The aim of this evidence-based project was to improve the medical screening process, enhance medical decision-making, and standardized the utilization of an adult traumatic brain injury neuroimaging guideline among advanced practice providers in a rural emergency department. Neuroimaging, specifically computed tomography (CT) scans, help to identify life-threatening intracranial injuries when clinically appropriate. The literature supports the utilization of neuroimaging guidelines, clinical exam, and provider expertise when identifying the need for a head CT scan. Although head CT scans are clinically useful, they increase healthcare costs and pose potential cancer risks from radiation exposure. Eight advanced practice providers (i.e., nurse practitioners, …
Exploring The Relationship Between Family Social Capital And Utilization Of Well Child Preventative Health Care Services, Kristi K. Westphaln
Exploring The Relationship Between Family Social Capital And Utilization Of Well Child Preventative Health Care Services, Kristi K. Westphaln
Dissertations
Background: Passage of the Affordable Health Care Act of 2010 increased insurance coverage for children, however possession of health care insurance doesn’t always equate to effective use of health care services. Misuse and underutilization of health care homes is associated with higher costs, fragmentation of health care, and poor health outcomes across the lifespan. Along with reliance upon the health care system, child health and well-being are dependent upon social factors such as interactions with caregivers and communities. Family social capital (FSC) addresses the interrelated nature of child health and family interaction while also promoting family cohesion as currency …
Orthopedic Nurse Practitioner As A Subspecialty: A Case Study, Debra M. Palmer
Orthopedic Nurse Practitioner As A Subspecialty: A Case Study, Debra M. Palmer
Dissertations
Purpose: The overall purpose of this study was to describe the ONP role by exploring how and why NPs are utilized in orthopedic health care settings. Two problems associated with the evolving ONP role were addressed: the concomitant decrease in the supply of and increased demand for orthopedic patient care services and the nursing profession’s unmet challenge to keep pace with that increased demand and protection of the public and nursing profession through credentialing of ONPs and programs providing certification and training for ONPs.
Approach: This study employed a single-embedded case study research approach to answer the research questions and …
Barriers And Perceptions To Obtaining Palliative Care In The Emergency Department, Jacqueline Lucille Saucier
Barriers And Perceptions To Obtaining Palliative Care In The Emergency Department, Jacqueline Lucille Saucier
Dissertations
Background:
Purpose: This study explored barriers and perceptions of providing palliative care services while patients are in the emergency department (ED) in order to increase the>likelihood of caregivers to elicit palliative care methodologies for patients with chronic illness, who are not necessarily at the end of life, but rather who are identified through repeated visits to the ED.
Design and Methods: A mixed methods approach was used to explore the barriers and perceptions of providing palliative care services in the ED. By using a qualitative approach, evidenced by grounded theory, this study explored the barriers and perceptions of providing …