Using Evidence-Based Interventions To Improve The Completion Rates Of Advance Care Directives, Fariba Sohrabi

Doctor of Nursing Practice (DNP) Projects

Background: Advance care directives reduce unnecessary suffering, improve life quality, and further engage patients and families in the decision-making process to ensure that end-of-life care preferences are considered and applied. Despite the proven benefits of advance care directives, advance directives completion rates are approximately 33% in the United States. Purpose: The purpose of this quality improvement project was to increase advance directive completion rates among patients at one clinic through an educational intervention. Methods: The intervention was used to educate patients about the benefits of advance care directives, and present opportunities for patients to complete the directive. The intervention included …

A Grounded Theory Of Patient Flow Management Within The Emergency Department, Ellen Benjamin

Doctoral Dissertations

Background: Emergency department (ED) crowding is an urgent threat to patient safety and negatively impacts healthcare staff and institutions. Patient flow researchers have employed a range of methods to address this crisis, including an increase in the use of operations research and operations management strategies. However, identified patient flow solutions are inadequate. Research describing the complexities of patient flow processes and investigating the work and contributions of ED nurses is needed. Purposes: The purposes of this study were to explore how ED nurses perform patient flow management and to develop a constructivist grounded theory of patient flow management within the …

The Meanings Of Daily Activities And Attitudes Of Older Breast Cancer Survivors: A Case Study Research, Wadha Alquraini

Doctoral Dissertations

Objectives: The aim of the study was to explore how older breast cancer survivors made meaning from daily activities and their attitudes to life and behaviors in it. Method: Secondary data was analyzed from nine older women with breast cancer. Data on living women was used to elicit the influence of breast cancer on survivors' attitudes and behaviors. Results: Eight significant themes were identified that were related to breast cancer meanings, attitudes to it, and behaviors that impact participants' survivorship; breast cancer means death or being close to death, survivor-provider relationships, social support, the meaning of dignity or …

Mental Health Burden And Attitudes And Intention To Seek Mental Health Services In Saudi Women Living In The United States, Wjdan A. Almutairi

Doctoral Dissertations

Background: The number of Saudi nationals immigrating to the U.S. continues to increase. Saudi women immigrants may be at increased risk for mental health disorders, including depression and anxiety, due to immigration-related stressors such as language difficulties, family separation, and cultural adjustment. Purpose: The purpose of this study was to measure anxiety and depression levels in Saudi women living in the U.S. and to assess factors affecting their intention to seek mental health services in the U.S. Methods: A descriptive cross-sectional design was employed, using online self-reported surveys. The study included a convenience sample of 160 Saudi women living in …

Educating Novice Nurses And Nurse Practitioners About Military Sexual Trauma Screening, Alyssa D. Freeman

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Military sexual trauma prevalence has continually increased over the past 25 years. Exposure to sexual trauma, violence, and abuse result in notable health consequences. The Veterans Health Administration has led the integration of universal Military Sexual Trauma (MST) screening and training. Purpose: The purposes of this project were to educate novice nurses and nurse practitioners about MST and to increase their knowledge and comfort in MST screening techniques. Methods: Following an educational session, a pre- and post-study design was used to evaluate improvement in knowledge and comfort screening for MST. Thirty-two participants including PBRNR Nurse Residents, …

Improving Culturally Competent Lgbtq+ Care Among Primary Care Providers, Christopher Diaz

Doctor of Nursing Practice (DNP) Projects

Purpose: Although general efforts have been made to identify, address, and improve the standing of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, many of these individuals continue to experience stigmatization and discrimination daily. These experiences influence the health of these individuals, which leads to several health disparities including an increased risk for numerous physical and mental health conditions.

Methods: Using nationally developed guidelines, the author of this project developed two didactic-style educational presentations for primary care providers to improve cultural competency for LGBTQ+ individuals. Eight providers completed both presentations, which explored the attitudes, knowledge, and beliefs/practice intentions of …

A Toolkit To Adequately Screen Pregnant Women For Depression And Thus Increase Screening In An Outpatient Obstetrical Clinic, Katherine Doherty

Doctor of Nursing Practice (DNP) Projects

Background: Perinatal depression is a common health complication during pregnancy. Untreated depression among perinatal women is associated with adverse health outcomes for infants and mothers. Screening during the perinatal time period is needed to identify and treat depression and to prevent adverse health outcomes.

Purpose: The purpose of this clinical project is to equip health care providers with the knowledge and tools needed to screen pregnant women for depression and thus increase the amount of screening done in an outpatient obstetrical clinic.

Methods: An evidenced- based educational tool kit was developed to increase provider knowledge of perinatal depression …

Shared Decision Making For Primary Care Patients With Medical Complexities, Cori B. Fappiano

Doctor of Nursing Practice (DNP) Projects

No abstract provided.

Outcomes Of Directly Observed Therapy In People Living With Hiv Who Experience Homelessness And Substance Use Disorder, Mara C. Clawson

Doctor of Nursing Practice (DNP) Projects

Background: Antiretroviral directly observed therapy, in which nurses or other allied health professionals provide patients with daily medication, is an evidence-based solution for viral load suppression in people living with HIV who experience homelessness. Purpose: This quality improvement project aimed to assess the outcomes of antiretroviral directly observed therapy at one urban clinic caring for people living with human immunodeficiency virus who experience homelessness and substance use disorder. Methods: Data was collected from the electronic health record for the antiretroviral directly observed therapy patient cohort (n = 33); 10 of them were surveyed. Fisher exact tests determined nonrandom associations between …

Mindfulness Training In A Pediatric Practice With Adolescents And Young Adults, Rebecca Brady

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Access to support for behavioral and mental health in adolescents and young adults difficult. Depressive symptoms go unrecognized which can lead to severe symptoms, hospitalizations, and suicides. The lack of mental health services challenge the management of depression in this age group. Mindfulness may be a helpful tool in supporting mental health. Purpose: The purpose of this project was to improve depression symptoms among youth through engagement in mindfulness activities. Methods: A pre/post-intervention approach was used to measure the effectiveness of a synchronous, online educational platform to guide participants in mindfulness activities. Practice sessions were utilized based on …

Enhancing Transgender Informed Healthcare For Nursing Students: An Educational Intervention, Olivia Bass

Doctor of Nursing Practice (DNP) Projects

Background: Limited teaching of transgender related healthcare competencies is seen in baccalaureate nursing curriculum, resulting in inadequate preparation of healthcare providers to care for this population of patients. This discord can prevent transgender patients from seeking healthcare and affect access to needed services. Purpose: The purpose of this DNP project was to educate accelerated Bachelor of Science in Nursing students at an institute of higher education on providing culturally responsive healthcare for transgender patients. Methods: An in-person educational intervention focused on improving clinical and cultural knowledge for transgender patients was implemented and evaluated. A pre-intervention survey and post-intervention survey …

Implementation Of An Acne Management Smartset To Guide Primary Care Providers’ Management Of Acne Patients, Emily Thomas

Doctor of Nursing Practice (DNP) Projects

Background: Primary care providers (PCPs) commonly refer adult acne patients to dermatology due to lack of confidence in treatment initiation and maintenance, resulting in delayed patient care, limited access to dermatology appointments, and an ongoing knowledge gap within the primary care setting. Purpose: To support PCPs with acne diagnosis and treatment recommendations by hosting acne education sessions and implementing an Acne Management SmartSet for acne treatment. Methods: The DNP student held acne education sessions during staff meetings at two primary care sites, then disseminated surveys to participants to determine if the education session and SmartSet were clinically useful. Data pertaining …

Screening For Opioid Use Disorder In Emergency Department Observation Unit Patients, Kendra M. Cull (Lehman)

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Opioid use disorder (OUD) is an issue that impacts the healthcare system daily, and has been declared a national public health concern Purpose: The purpose of this DNP Quality Improvement (QI) project was to screen patients aged 16 and older for Opioid Use Disorder (OUD) who presented to the Emergency Department Observation Unit (ED OBS) in a Urban Academic Medical Center regardless of chief complaint. The goal of this project was early identification of OUD and rapid referral to outpatient resources to facilitate recovery compliance. Methods: The QI project utilized a registered nurse led screening …

Use Of A Checklist As A Decision Support Aid For Heart Failure Assessment And Management, Maryann Hogan

Doctoral Dissertations

Heart failure is a serious chronic health problem requiring ongoing management to control disease progression. Consequences of inadequate heart failure management include acute exacerbation, worsening baseline status, and possibly death. Nurses play a key role in surveillance of patients with heart failure and in management of their condition as part of the interprofessional health care team. During episodes of acute decompensation of heart failure, nurses must be able to detect onset of signs and symptoms, initiate appropriate nursing interventions promptly, and communicate with the provider and other team members as needed. Although heart failure is a common health problem in …

Physical Activity, Daily Step Counts And Functional Ability In Older Adults: Using Nhanes Database, Chunfang(Maggie) Chen

Doctoral Dissertations

Maintaining functional ability and independence are essential in the healthcare of older adults. Physical activity(PA) has been acknowledged as effective and economical health promotion strategies in older population. However, the amount of PA needed to maintain functional ability in older adults remains unclear. This investigation used PRISM Dose-response Curves Stimulation Variable slope model to explore the relationships between the amount of PA and functional ability in community-dwelling young-old, middle-old and old-old age group adults. ANOVA analysis was used to examine the relationship between functional ability and self-perceived active level changes compared to 10 years ago. NHANES 2005-2006 older participants datasets …

The Experiences And Needs Of Individuals With A Variant Of Uncertain Significance (Vus) On Genetic Tests For Hereditary Cancer Syndromes: A Grounded Theory Study, Danielle Gould

Doctoral Dissertations

Background: The use of multigene panel testing for identifying individuals with hereditary cancer susceptibility has expanded in recent years. The number of individuals who have a variant of unknown significance (VUS) result is increasing. However, little is known about the experiences and needs of this group. This study’s purpose was to describe the experiences and needs of individuals with a VUS result by focusing on their experiences in communicating with healthcare providers and family members. Methods: A constructivist grounded theory approach was used. Recruitment took place from January–July 2021 through social media: the Prospective Registry of Multiplex Testing (PROMPT), and …

Improving Dementia Caregiver Competency In Nursing Home, Disha Bhattacharya

Doctor of Nursing Practice (DNP) Projects

Background: Inadequate training of dementia care providers in nursing homes lead to adverse health outcomes in patients with dementia.

Purpose: To educate and train dementia caregivers in a nursing home to improve dementia care.

Methods: A Quality Improvement Project (QIP) was implemented in a nursing home with nine nurses engaged in two virtual education group sessions led by the DNP student over an eight- week timeframe. Topics discussed included education on the nature and progress of dementia, building trust with dementia patients, managing their behavior, communication strategies, and self-care. Pre-training and post-training surveys were completed prior to …

Postpartum Hemorrhage: Improving Patient Outcomes With Improved Communication And Post-Drill Debriefing, Sheila L. Lafortune

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: A woman is at risk of dying from postpartum hemorrhage every four minutes. Maternal hemorrhage is found to be the direct cause of maternal mortality, overall accounting for 27% to 75% of maternal deaths worldwide. In the United States, 54% to 93% of maternal mortality could have been prevented. Postpartum hemorrhage remains among the top causes of pregnancy-related deaths worldwide. The purpose of this project is to educate providers of obstetrical care regarding best practices for effective communication during a postpartum hemorrhage by implementing a debriefing educational tool during postpartum hemorrhage mock code drills. Methods: The postpartum …

Acute Care Nursing Education To Enhance Aggression Management Skills, Marybeth Hayes

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Workplace Violence (WPV) in healthcare settings is pervasive. Acute care nursing staff experience higher rates of aggression from patients. These experiences may cause physical and psychological injury to caregivers and stress healthcare systems.

Purpose: The purpose of this quality improvement (QI) project was to strengthen understanding of evidence-based principles for management of aggressive patients on acute care medical units. Education enhances nursing staff sense of self-efficacy and clinical reasoning skills and is associated with effective management of aggression. Ultimately, improved management of aggression may lead to lower rates of patient assault towards staff members.

Methods: A pre and …

Use Of Public Health Detailing To Improve Provider Practice In The Clinical Management Of Syphilis, Tessa A. Robinson

Doctor of Nursing Practice (DNP) Projects

Background: Throughout history, syphilis has been a challenge to manage and control until the invention of penicillin in 1943 was available. Even with effective treatment, the diagnosis and clinical management of syphilis remains a challenge for providers. Purpose: The purpose of this project was to increase provider knowledge of evidence-based practice in the clinical management of syphilis, using public health detailing, to decrease inadequate and delayed identification and treatment of syphilis. Methods: Providers from a federally qualified health center (FQHC) participated in one public health detailing visit during March of 2021. Each provider completed a Provider Practice …

Standardizing Behavioral Health Triage: Using The Heads-Ed Tool, Sarah K. Peifer

Doctor of Nursing Practice (DNP) Projects

Background: In the past two years emergency departments across the country have experienced an increase in pediatric patients requiring behavioral health care. It is essential to provide efficient, early intervention to these vulnerable patients. The use of a standardized tool can improve management of pediatric patients and allow access to resources in a timely manner.

Purpose: To evaluate the implementation of the HEADS-ED in a community hospital ED, to provide rapid behavioral health assessment.

Methods: Education for staff was provided through various platforms and involved regular support for staff throughout the intervention. It was hypothesized that implementation of …

Transition Readiness Tools To Improve Health Care Transitions Among Adolescents With Inflammatory Bowel Disease, Meagan Moffett

Doctor of Nursing Practice (DNP) Projects

Inflammatory bowel disease is associated with severe disease in pediatric patients often requires treatment through adulthood. Collaborative efforts of patients, families, and health providers are needed to foster a smooth transition of care from pediatric to adult health care.

The purpose of this quality improvement project was to establish a baseline understanding of transition readiness among adolescents at one gastroenterology clinic to improve transition to adult care. A cross-sectional design was used to assess adolescents’ readiness for transition of care over a three-month period. Transitioning Readiness Assessment Questionnaire (TRAQ) was administered followed by individualized education on topics covered in the …

Promoting Exclusive Breastfeeding Among Racing/Ethnic Minority Women For The First Six Months, Linda A. Boateng

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Breastfeeding is the recommended way of feeding infants due to the numerous health benefits. However, racial/ethnic minority women in the United States are less likely to initiate and maintain breastfeeding for the recommended six months compared to white women. This has resulted in higher health issues such as obesity, diabetes type I, allergic sensitivity, acute otitis media, and gastrointestinal problems among racial /ethnic minority children. Purpose: The purpose of this Quality Improvement Project was to promote exclusive breastfeeding among racial/ethnic minority postpartum mothers for the first six months. This was done by providing breastfeeding education to postpartum nurses …

Perceptions Of The Flu Vaccine In The Setting Of Covid-19, Lauren A. Vogel-Hanley

Doctor of Nursing Practice (DNP) Projects

Background: Vaccination is a key component to public and personal preventative health. The COVID-19 pandemic has illuminated the need for further research into how best to encourage vaccination, especially in harder to reach or vulnerable populations.

Purpose: This project sought to evaluate beliefs and perceptions of the flu vaccine in the context of the COVID-19 pandemic and to explore the views of the project site’s population in order to develop more targeted educational programs for increasing flu vaccination. The project focused on the ambulatory population of the emergency department.

Methods: The survey tool administered was based on the National Flu …

Addressing Implicit Bias To Improve The Engagement And Retention Rate Of The Under-Represented Minorities In Substance Use Treatment., Adekemi Victoria Adeleye

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Racial and ethnic minorities' care for substance use disorder is negatively affected by biases, prejudices, and stereotypes in healthcare. This has created a general mistrust of the healthcare system and has constituted a barrier preventing minority patients from seeking care. Implicit biases are harmful, and this project aimed to bring awareness to this issue through educational activities to empower nurses in recognizing the problem.

Methods: Twelve nurse-care managers in an outpatient addictions treatment clinic volunteered to participate in an educational session on implicit bias and its impact on the healthcare environment. The training involved an interactive presentation …

Fall Prevention Program For Adults With Intellectual Disabilities, Marie Ambroise

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of Literature: Adults with intellectual disabilities are vulnerable to falls. Proper intervention results in enhanced health outcomes. Implementing Otago Exercise Program (OEP), an evidence-based exercise intervention, has been shown to reduce fall rates among adults with ID.

Purpose: To use evidence-based preventive measures for reducing falls among intellectually disabled mental health facility residents over the age of 55.

Methods: An OEP was provided to adults with Intellectual Disabilities aged 50 and above at a chronic mental health facility for eight weeks. The implementation involved four phases. Phase one included organizing meetings with stakeholders and gathering …

Enhancing Preventative Health Care For Latino Migrant Dairy Farm Workers In Addison County, Vermont, Elizabeth A. Douglas

Doctor of Nursing Practice (DNP) Projects

Background: Latino dairy farmworkers, mainly from Mexico and Guatemala, help produce over 50% of Vermont’s milk. Latino dairy farmworkers may not seek health care for many reasons, including fear of immigration/law enforcement, language barriers, lack of transportation, and cost of care. Purpose: The purpose of this DNP project was to increase the utilization of health care services, including immunizations, of migrant farmers by educating and providing information about preventative, curative, and support services available in southern Vermont (VT). Methods: The intervention, one 60-minute educational program session took place at a local church service for migrant farmers, and an informational pamphlet …

Improvement Of Overweight And Obesity Screening And Intervention In Primary Care, Catherine Lehtinen

Doctor of Nursing Practice (DNP) Projects

Background: Obesity is a chronic health condition, resulting in significant morbidity and mortality, and is inadequately managed and treated in primary care. The Obesity Pathway is an organization-specific algorithm for providers to treat patients with obesity.

Purpose: To improve provider use of an Obesity Pathway in a primary care clinic and to increase the screening and intervention of all adult patients with overweight or obese status.

Methods: The Obesity Pathway was reviewed with primary care providers as well as best practices for weight management, obesity bias and stigma. The NEW Attitudes Scale and satisfaction surveys were completed by providers before …

Implementing Intimate Partner Violence Screening In The Primary Care Setting, Deirdre F. Howard

Doctor of Nursing Practice (DNP) Projects

Background. Intimate partner violence is a highly prevalent problem in the United States and leads to serious negative physical and psychological health outcomes, including death. There are screening tools that can detect IPV, yet screening rates in healthcare settings remain low, due to a variety of barriers, including lack of time, confidence, screening policies, and resources. Purpose. The purpose of this DNP project was to increase IPV screening rates within a primary care clinic.Methods. To accomplish the purpose of the project, an education intervention on IPV and available resources was provided to clinicians and staff. This was followed by …

Improving Telehealth Knowledge And Comfort In An Older Adult Population, Carolyn J. Jones

Doctor of Nursing Practice (DNP) Projects

Background: Telehealth usage is increasing a means of providing healthcare in a more efficient and cost-effective way. Older adults have been left behind from the telehealth movement and this can negatively impact their access to the healthcare system.

Purpose: An educational workshop was offered in a local older adult community with the goal of increasing their knowledge, literacy, motivation, and usage of telehealth.

Methods: The participants completed a pre-assessment survey to determine their baseline knowledge, experience, and perceptions about telehealth. They then participated in an educational workshop, which consisted of a 45-minute presentation given via Zoom with a 15-minute …