Medicine and Health Sciences Commons^™

Delivery Of Evidence-Based Tobacco Use Interventions In Primary Care, Amber Silberman

DNP Projects

This capstone report presents three manuscripts which focus on tobacco use interventions in the primary care setting. The first manuscript presents a critical analysis of the Public Health Service guideline on Treating Tobacco Use and Dependence. The second manuscript presents a literature review pertaining to interventions that increase primary care provider compliance with guideline recommendations. The literature obtained from these first two manuscripts led to a descriptive study, which examined the documentation and implementation of specific guideline recommendations in a primary care clinic. The third and final manuscript details this study, and presents some practical implications for improving documentation …

Evidence-Based Blood Conservation Education For Icu Nurses: A Pre And Post-Test Evaluation Of Nursing Knowledge, Stefanie M. Bull

DNP Projects

Purpose: The purpose of this evidence-based education project was (i) to evaluate baseline nursing knowledge of anemia, blood conservation and transfusion medicine, (ii) to identify current blood conservation practice and the nurse’s prior exposure to blood conservation education (iii) to determine the potential impact of evidence-based education on nursing knowledge, and (iv) to determine the impact of education on the nurse’s attitudes towards future implementation of blood conservation practices based on the nurse’s self report.

Setting: The project was implemented in the Cardiovascular and Thoracic ICU (CVICU) at an 875-bed level-1 Trauma and Multi-Organ Transplant Center located in central Kentucky. …

Tobacco Treatment In College Students, Teresa H. Huber

DNP Projects

This study was conducted in a southeastern University to determine tobacco use status in a population of university students, student intention to quit, treatment options, use of student health service, and student’s degree of support of a tobacco-free policy. A major implication for practice is the need for college health providers to screen all students utilizing the USPHS Guidelines, as even light smokers may be vulnerable to nicotine addiction. However, the study found that a high proportion of the smokers were nondaily smokers who do not consider themselves as smokers and the vast majority of those were undergraduates. Thus, college …

Post-Laminectomy Back Pain: Understanding The Progress From Acute To Chronic Pain State, James Derek Calhoun

DNP Projects

In the United States, 74.6% of patients who have lumbar laminectomy surgery have residual low back pain (Hussain & Erdek, 2014) and overall costs of low back pain may reach up to $200 billion per year (Carey & Frebuger 2013). To further address this problem, a study was conducted to determine if treatment in a chronic pain clinic could result in a reduction in the development of a chronic pain state for adult patients who have had lumbar laminectomy surgeries. A convenience sample of 50 patients was selected from the Interventional Pain Associates clinic at the University of Kentucky. Records …

Assessing Provider Knowledge And Attitude Towards Animal-Assisted Therapy As A Complementary Treatment For Children, Shannon Leigh Million

DNP Projects

Objective: The purpose of this project was to determine knowledge and attitudes of pediatric primary care providers working in a university outpatient clinic settings towards the use of animal-assisted therapy as a complementary treatment for children. This report also includes an integrative review of animal-assisted therapy in pediatric populations and a clinical practice guideline analysis regarding the use of equine facilitated learning with high risk children and adolescents in residential psychiatric treatment.

Methods: A survey tool was administered to the Department of Pediatrics at UK Healthcare.

Results: There were 41 respondents to the survey, 36 of which …

Trauma Resuscitation Team Program Evaluation, Lisa J. Fryman

DNP Projects

To evaluate the effectiveness of a newly implemented charge nurse-led trauma resuscitation team approach in the Trauma Intensive Care Unit (TICU). The approach was developed to improve patient throughput efficiency at a Level 1 Trauma Center. Measures of effectiveness include patient throughput efficiency, patient clinical outcomes, and financial impact. The implementation of the charge nurse-led trauma resuscitation team showed an improvement in efficiency of patient throughput without adversely affecting patient outcomes, and opening up critical resources for the next patient that arrives.

Screening For Sepsis: A Key Strategy For Early Identification And Management Of Septic Patients, Amy P. Fisher

DNP Projects

Background: Sepsis, defined as a systemic inflammatory response to infection, is a life-threatening medical condition that rapidly progresses from severe sepsis (characterized by signs of organ dysfunction) to septic shock with fluid-refractory hypotension. Adherence to the Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock have been associated with improved delivery of care and reduced mortality. Delays in recognition of sepsis has been identified as a barrier to achieving early goal-directed therapy targets.

Purpose: To determine if a sepsis screening protocol could facilitate earlier identification of patients with sepsis

Methods: A retrospective medical record review was …

Assessing Prevalence Of Known Risk Factors In A Regional Central Kentucky Medical Center Heart Failure Population As An Approach To Assessment Of Needs For Development Of A Program To Provide Targeted Services To Reduce 30 Day Readmissions, Christeen Ivy Broaddus

DNP Projects

Abstract

Objectives:

1. Determine demographic, physiologic, and laboratory characteristics at time of admission of the heart failure (HF) population in a regional acute care facility in Central Kentucky through review of patient electronic medical records.
2. Determine which HF population characteristics are significantly associated with readmissions to the hospital.
3. Provide identification of the statistically significant common characteristics of the HF population to this facility so that they may work towards development of an electronic risk for readmission predictive instrument.

Design: Retrospective chart review.

Setting: Regional acute care facility in Central Kentucky.

Participants: All patients (n = 175) with a diagnosis or history …

Implementation Of A Depression Screening Protocol Specific To Implantable Cardioverter Defibrillator Patients; A Quality Improvement Project, Kendra M. Kratzwald

DNP Projects

Background: Depression in patients with implantable cardioverter defibrillators (ICD) is a problem that has not been well addressed by providers. In 2012 the American Heart Association (AHA) released a scientific statement that recommended structured and routine depression screening of these patients. The AHA statement also recommended further research on depression screening instruments and their use with this population. Aims: 1.) To develop and implement an evidenced based depression screening protocol appropriate for patients with an ICD seen in an outpatient setting. 2.) Evaluate provider knowledge about depression screening (? Is this what you mean) and depression screening practices before and …

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …

The Effect Of Coaching On Nurse Manager Leadership Of Unit Based Performance Improvement: Exploratory Case Studies, Cynthia A. Baxter

DNP Projects

The nurse manager role has experienced an explosion of responsibilities and expectations over the last decade. As a result, competency and skill acquisition for the successful nurse manager has become the focus of many nurse managers, nurse executives, researchers and organizations. The three manuscripts contained in this final capstone report will explore the acquisition of nurse manager competency, propose coaching as a methodology for acceleration and improvement of nurse manager skill acquisition and describe the results of three case studies using coaching as an intervention to improve the performance improvement skill acquisition of nurse managers.

Military Tobacco Dependence Treatment: Implications Of Treatment Type On Abstinence And Weight Management Ability, Bradley A. Briscoe

DNP Projects

Military readiness, employer productivity and individual health are all significantly impacted by high rates of tobacco use. Current research, to date, suggests that use of brief, individually tailored behavioral modification strategies through group therapy may be most effective in smoking cessation. The objective of this Practice Inquiry Project was to explore aspects of tobacco use the U.S. military population and examine potential relationships between type of treatment, smoking abstinence, and maintenance of body weight (e.g. avoid weight gain) among those seeking tobacco use cessation. The findings of this project can provide guidance on enhancing current tobacco cessation efforts to enable …

Educational Materials And Brief Counseling Improve Diabetes Knowledge And Self-Efficacy, Tamara K. Wellman

DNP Projects

Purpose: The purpose of this study was to see if education and counseling of the Appalachian individual with diabetes and a family member/friend would improve knowledge of the disease and self-efficacy of the patient in regard to their diabetes care.

Setting: The setting was one of eight primary care offices of Our Lady of Bellefonte Hospital, Bon Secours, located in the Ashland, Kentucky.

Design: A pilot study of descriptive, comparative design was used.

Subjects: Data were collected from a convenience sample of patients with type 2 diabetes (n=15) that were established at the primary care office and their family members/friends …

Evaluating Discharge Readiness Of Patients At A Primary Stroke Center, Amanda Green

DNP Projects

The diagnosis of stroke is very prevalent in healthcare and it is estimated that someone in the United States suffers from a stroke every 40 seconds (Lloyd-Jones et al., 2009). In order to optimally prepare these patients for discharge and improve patient outcomes, it is important to understand the needs of the patient and caregiver and to meet these needs. In order to evaluate this, the focus of this project was to evaluate the discharge readiness of patients at a primary stroke center. “Discharge Needs of the Stroke Patient and Caregiver” focuses on a review of the literature in order …

Predicting The Risk Of Obstructive Sleep Apnea And Difficult Endotracheal Intubation In A Surgical Population In A Rural Community Hospital Setting, Craig S. Atkins

DNP Projects

Purpose:

The purpose of this paper is to provide a theoretical framework with practical application for facilitating patient flow through the operative process using the Lean philosophy to minimized delays and cancellations.

Theoretical orientation:

Efficient, quality patient care has always been the hallmark of Nurse Anesthetist practice. Lean healthcare introduces continuous quality improvement (CQI) processes used in Lean manufacturing to the healthcare system. The principal aspect of Lean healthcare is the concept of a value stream where work is standardized, work flow is streamlined and waste is eliminated, thus creating value.

Nature of Review:

In the surgical suite waits, delays …

Evaluation Of Depression Screening Practices For College Women In A Primary Care University Health Clinic, Sarah E. Lester

DNP Projects

Mental disorders, including depression, are increasing in frequency and intensity in the college student population. College-aged women appear to be particularly vulnerable to depression. Primary care providers play an important role in addressing this issue, as they are the principal health care contacts for more than 50% of patients with mental illnesses. Guidelines from the 2009 United States Preventative Services Task Force recommend screening all adults (age 18+) for depression in primary care when depression care supports are in place. However, current screening rates for depression in the primary care setting from are estimated at only 1.6 to 3.3% (United …

Tobacco Treatment In College Health, Joanne Brown

DNP Projects

ABSTRACT: Tobacco Treatment in College Health

The college years are a critical time in the development of smoking behavior and tobacco use. Smoking is linked to 30% of cancer deaths, 80% of deaths from chronic obstructive pulmonary disease and early cardiovascular disease and death. Effective treatment interventions at this time provide an opportunity to drastically reduce premature morbidity and mortality.

This document follows the progression from the discussion of the problem to evaluation of an intervention. The first manuscript is a review of existing literature on Internet interventions with young adults, including methodology, theoretical frameworks and outcome measures for tobacco …

An Evidence-Based Toolkit For Human Papillomavirus Vaccine Education Of Female Adolescents In The School Setting, Nancy R. Kloha

DNP Projects

A new vaccine to prevent human papillomavirus infection was approved in 2006 in the United States (U.S.). Uptake of the vaccine has been less than optimal (CDC, 2010c). New venues for promoting vaccine acceptance are needed (Middleman & Tung, 2010). The goal of this capstone clinical project is to create an evidence based toolkit for use by school nurses in educating female adolescents, parents, communities and other healthcare providers about the HPV vaccine.

Schools nurses have daily access to young people in the target group for HPV immunization. A vital component of vaccine acceptance is education of those who are …

A Systematic Approach To Manage Clinical Deterioration On Inpatient Units In The Health Care System, Colleen H. Swartz

DNP Projects

The transformation of health care delivery in the United States is accelerating at unbelievable speed. The acceleration is a result of many variables including health care reform as well as the covariation occurring with adjustments in regulations related to resident work hours. The evolving care delivery model has exposed a vulnerability of the health system, specifically in academic medical centers of the United States. Academic medical centers have established a care delivery model grounded and predicated in resident presence and performance. With changes in resident work expectations and reduced time spent in hospitals, an urgent need exists to evaluate and …

Evaluation Of Testing And Implementation Of Evidence-Based Rn Bedside Swallow Screen For Dysphagia: A Clinical Practice Change, Edith Matesic

DNP Projects

Stroke patients initially experience dysphagia approximately 42 - 67% of the time with noted improvement reducing rates to approximately 43% at seven days post-acute event (Perry & Love, 2001). The dysphagia experienced by these patients makes them at high risk to develop aspiration pneumonia. Overall, the financial impact of reducing aspiration pneumonia reduces the national cost of morbidity, mortality, and disability burden in this population. There is no generally recognized swallow screen. Program evaluation objectives were to establish a valid, reliable, cost effective, and easy to administer evidence RN bedside swallow screen for dysphagia to keep acute stroke patients safe …

Self Reported Pain Diary For Assessment Of Chronic Pain In The Communicative, Cognitively Intact Nursing Home Resident, Kathy K. Hager

DNP Projects

This paper describes a clinical project using a self-reported pain diary for the assessment of chronic pain in the communicative, cognitively-intact nursing home resident. There are estimates of chronic pain among nursing home residents that range from 4 – 83%. The goal of this clinical project was to evaluate a chronic pain diary in relation to its effectiveness and efficiency in accurately assessing pain among nursing home residents. Assessment has been identified as a major barrier in the control of chronic pain, and the self-report is accepted as the most reliable measure of a person’s pain. The self-reported pain diary’s …