Medicine and Health Sciences Commons^™

Lung Cancer Screening In A Primary Care Clinic For Coal Mine, Glenda Mills, Sarah Cobb

Doctor of Nursing Practice Projects

Lung cancer is the leading cause of mortality for both men and women in the United States. Guidelines are set by the American Cancer Society for annual screenings of at-risk patients. Early identification of lung cancer risk and screening with low-dose CT scans can increase detection and treatment thereby reducing risk of death or disability. Coal miners are exposed to numerous cancer-causing agents, such as toxic chemicals, dust pollution from coal, and diesel exhaust fumes. However, primary care clinics serving coal miners lack lung cancer screenings despite the increased risk miners face. Patients were screened using criteria set forth by …

Brining Point-Of-Care Ultrasound To A Rural Primary Care Clinic, Caleb E. Migda

Culminating Experience Projects

Background and Objectives: In the rural primary care setting, the process for outpatient

ultrasound testing has multiple steps, all of which provide opportunities for delay in testing and diagnosis. Point-of-care ultrasound (POCUS) is a solution that allows the physician to perform same-day ultrasound in the primary care clinic. The objective of this program development project was to implement POCUS in a rural primary care clinic to reduce time to testing and diagnosis for those patients requiring ultrasound testing.

Methods: A 3-month chart audit was conducted to examine the average length of time required to complete ultrasound testing in the outpatient …

Lung Cancer Screening In Primary Care, Ellen Macdonald

Masters Theses/Capstone Projects

A chart audit was completed in a central Ohio primary care office to evaluate the compliance of lung cancer screening according to guidelines set forth by the USPSTF.

Screening For Social Determinants Of Health In The Primary Care Setting: A Quality Improvement Project, Winifred Ann Shouse

Graduate Theses, Dissertations, and Capstones

Social determinants of health are the conditions in which individuals are born, age, work, and live that affect health status and outcomes (Rivich et al., 2019). These social and environmental factors can create barriers to patients being able to access and adhere to recommendations for chronic disease management (Gold, et al., 2019). Communication gaps between patients and primary care providers make it challenging for healthcare providers to be completely aware of the financial burdens their patients encounter (Patel et al., 2016). Research supports that identifying and addressing the barriers related to social determinants of health can improve the management of …

Diabetes Self-Care Management Education For Advanced Practice Registered Nurses In Primary Care Setting, Rebecca Anne Griggs-Galyean

Walden Dissertations and Doctoral Studies

Type 2 diabetes mellitus is a preventable chronic condition that affects many members of the U.S. population. Diabetes is associated with comorbidities including cardiovascular disease, end-stage renal disease, hypertension, neuropathy, and lower limb amputations, leading to increased mortality. Patient self-care education has been shown to improve adherence to diabetes self-care (DSC) in the primary care setting. However, advanced practice registered nurses (APRN) in the local primary care setting lacked knowledge of DSC. Therefore, nursing knowledge of DSC was needed. The project question asked whether staff education on the use of the Association of Diabetes Care and Education Specialists 7 (ADCES7) …

A Nursing Staff Education Module On Survivorship Care Plans In Primary Care, Janette Francis

Walden Dissertations and Doctoral Studies

Survivorship care plans (SCPs) bridge the gap in the transition of care from oncology to primary care providers (PCPs) for breast cancer survivors. Despite strong recommendations for SCPs, their use remains limited. Guided by Knowles’ adult learning theory, the project focused on, first, determining whether a predeveloped staff education activity was valid using the Lynn model criteria for validation. Second, if in a rural clinic where SCP were not consistently used providers, nurses, and staff knowledge regarding the importance of SCP would increase following an educational program. An expert panel of 5 educational experts validated the educational module for appropriateness …

A Nursing Staff Education Module On Survivorship Care Plans In Primary Care, Janette Francis

Walden Dissertations and Doctoral Studies

Survivorship care plans (SCPs) bridge the gap in the transition of care from oncology to primary care providers (PCPs) for breast cancer survivors. Despite strong recommendations for SCPs, their use remains limited. Guided by Knowles’ adult learning theory, the project focused on, first, determining whether a predeveloped staff education activity was valid using the Lynn model criteria for validation. Second, if in a rural clinic where SCP were not consistently used providers, nurses, and staff knowledge regarding the importance of SCP would increase following an educational program. An expert panel of 5 educational experts validated the educational module for appropriateness …

Evaluating Kentucky Advanced Practice Registered Nurses’ Confidence, Comfort, And Knowledge Levels Regarding Dermatology Care After A Web-Based Video Training, Victoria Hayden

DNP Projects

Background: It can take an average of 38.9 days to see dermatology from referral to initial appointment. As a result, delays in diagnosis and treatment of life-threatening conditions such as malignant melanoma could occur. Primary care providers frequently refer patients for benign conditions that can be appropriately managed in the primary care setting; often due to lack of knowledge or confidence in their clinical management skills. Educational resources equip providers with the knowledge and tools to feel confident in their management of various skin conditions in a primary care setting. Purpose: The purpose of this project was to …

Addressing Perceived Barriers To Screening For Adverse Childhood Experiences In Primary Care, Trenton Conway

Dissertations

Problem: Inconsistent screening for Adverse Childhood Experiences (ACEs) in primary care settings leads to fewer appropriate behavioral health (BH) referrals and may increase risk for and incidence of chronic health conditions.

Methods: This quality improvement (QI) project used a descriptive observational design with prospective and retrospective data collection. The CDC’s ACE screening tool was administered to patients 18 years and older presenting to primary care. Data collection included number of ACE screenings completed and the number of BH referrals made following the screening. In additional, information was collected from medical assistants (MAs) and providers about the ACE screening process.

Results: …

Physician Orders For Life-Sustaining Treatment (Polst) Forms In A Primary Care Setting, Elena Johns

Doctor of Nursing Practice Final Manuscripts

Purpose: To increase completed POLST forms among elderly patients aged seventy-seven and older with chronic/debilitating illnesses, by at least 50% in a Primary Care clinic setting, from September 2021 to January 2022. Background: The government pays for over two-thirds of healthcare costs for the elderly aged sixty-five and older. Furthermore, by ages seventy to ninety, medical spending more than doubles. Many elderly and chronically ill patients report that they would prefer less aggressive treatment and more comfort care measures. However, patients also report a lack of knowledge about their end-of-life (EOL) wishes particularly when it comes to completing the Physicians …

Implementation Of Prep Protocol In Primary Care, Myia Harper, Catalina West

Doctor of Nursing Practice Projects

Human immunodeficiency virus (HIV) is an incurable condition that continues to be a public health threat. Approximately 38 million people live with the disease worldwide, and one out of seven are unaware they have the disease. Pre-exposure prophylaxis (PrEP) is a medication that can be prescribed to individuals at risk of acquiring HIV. PrEP can be prescribed by any healthcare provider who deems a patient at risk for HIV. However, a primary care practice in central Illinois previously had no protocol for initiation of PrEP. This quality improvement (QI) project aimed to implement a PrEP protocol in the department of …

Hypertension Management In Primary Care Using Target:Bp; Meeting Patient Goals And Quality Measures, Hollie Yoder

Doctor of Nursing Practice Projects

Hypertensive disease is a global problem impacting millions of individuals aged 18 years and above. Uncontrolled hypertension management can lead to significant complications and death . Primary care providers are challenged to improve patient outcomes in patients with hypertensive disease while complying with clinical quality measures for high blood pressure as outlined by the Center for Medicare and Medicaid Services Merit-based Incentive Payment System (MIP) performance measures. The purpose of this project was to improve high blood pressure in patients diagnosed with primary hypertension utilizing the American Heart Association (AHA) and the American Medical Association (AMA) Target: Blood Pressure (BP) …

Increasing Healthcare Provider Engagement With Adult Patients Regarding Organ Donation In The Primary Healthcare Setting, Evelyn Michelle Rainey

DNP Projects

Though 90% of the United States population supports organ donation, only 60% actually sign up as registered donors (Health Resources & Services Administration [HRSA], 2021). This 60% makes up approximately 169 million Americans, but the chances of actually becoming an organ donor are only 3 in 1,000 (Health Resources & Services Administration [HRSA], 2021). Simply put, the need for organs far outweighs the availability of those organs for transplant. Literature reviewed supports that a lack of knowledge regarding organ donation may contribute to the decreased number of registered organ donors and that Primary Care Providers (PCP) have been successful at …

Primary Care Provider Education On Behavioral Interventions For Management Of Adult, Rose Chinasa Kajuru

Walden Dissertations and Doctoral Studies

The high prevalence of obesity continues to pose significant health challenges globally. According to the U.S. Preventive Service Task Force, obesity affects more than 35% of men and 40% of women in the United States. The national annual cost of medical care related to obesity is estimated at $147 to $210 billion. Intensive behavioral interventions in adults with obesity can lead to clinically sufficient improvements. The project aimed to determine if the current evidence-based clinical guideline of behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults would improve primary care providers’ knowledge of adult obesity management. The …

Using The Samscore Questionnaire To Increase Skin Cancer Risk Screenings At Adult Patient Annual Exams, Taylor Abner

DNP Projects

Background: Malignant melanoma has become an increasingly prevalent problem in the United States. The earlier a skin cancer is identified, the better the outcome. There are conflicting recommendations about screening for skin cancer but in general identifying high risk patients is important and it is not being achieved in primary care.

Purpose: The purpose of this study is to evaluate use of the SAMScore Questionnaire to determine high risk patients at adult annual visits.

Methods: This was a multi-phased study with a quasi-experimental design that took take place at a family and community primary care clinic in central Kentucky. Baseline …

Increasing Low-Dose Ct Screening In Primary Care, Bethany Huelskoetter

Doctor of Nursing Practice Projects

Abstract

Lung cancer was ranked as the second most common cancer diagnosed in 2020 and had the highest death rate compared to all other cancers, excluding nonmelanoma skin cancers (ACS). Early detection is key in decreasing the mortality of lung cancer. A low dose CT (LDCT) is a yearly screening tool developed to detect lung cancer early in high-risk patients yet is much underutilized in primary care. The purpose of this project is to increase the number of LDCT orders placed for qualified patients to decrease the lung cancer mortality rate. There were two main methods for this project: education …

Improving Skin Cancer Screening In Primary Care, Jaclyn Barnhouse, Rebecca Baietto

Doctor of Nursing Practice Projects

Skin cancer is one of the most common forms of cancer in the United States, with melanoma having the highest rate of mortality of all forms of skin cancer (CDC, 2019). However, there is hesitancy among primary care providers to perform skin cancer screenings (Oliveria et al., 2011). Prevention and early detection of melanoma is key. Melanoma has been known to be highly curable when found early. This makes early detection even more important in order to prevent metastasis and potential mortality (Bruce et al, 2017). The use of targeted screening tools can potentially save lives when utilized in primary …

A Program Evaluation To Assess Readiness For The National Committee For Quality Assurance’S Patient Centered Medical Home Model Application, Alida M. Semrinec

Doctoral Projects

The Patient Centered Medical Home Model is associated with enhanced patient experience and quality improvement outcomes. The Model has the capacity to guide primary care practices to enhance quality, provide more comprehensive, patient centered care, and increase practice revenue. An urban, nurse managed community health center that has recently implemented the nurse care manager role (a Model requirement) desires to apply for recognition. A program evaluation was conducted to assess current practice, policies, and procedures in place at a Community Health Center through the lens of the National Committee for Quality Assurance’s forty Patient Centered Medical Home Model core competencies. …

Smart Phrase Revision To Improve Primary Care Pre-Visit Planning Workflow, Kelly Dobler

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Preventive care has been shown to improve health outcomes yet is underutilized. Use of Pre-visit Planning (PVP) smart phrases or templates in the EHR improve visit workflow and patient care. This project assessed current PVP smart phrase utilization and implementation of revised PVP smart phrases in a primary care setting.

Methods: Medical providers were surveyed to assess their satisfaction with the current PVP smart phrase. Based on those findings and evidence from literature a revised PVP smart phrase was developed. It was implemented and adapted over a 7 week period using four Plan Do Study Act (PDSA) cycles. A …

Faculty Perceptions Of Preparing Bachelor Of Science In Nursing-Registered Nurse Students For Primary Health Care, Gloria J. Hopkinson

Walden Dissertations and Doctoral Studies

Healthcare systems rely on nurses to provide essential healthcare services in primary healthcare settings. However, few nursing school graduates seek careers in primary healthcare (PHC). The purposes of this exploratory, qualitative study guided by the patient-centeredness theory were to explore the beliefs and attitudes of nursing faculty who teach Bachelor of Science in nursing level PHC courses, how they incorporate PHC into the nursing curriculum, and what strategies they use to promote student interest in PHC. Participants of this study included seven faculty who teach PHC courses at two universities in the Midwest. The interviews were audio recorded, transcribed, and …

Transition Of Care For Discharged Patients, Rolando Ramos

Student Scholarly Projects

Practice Problem: The 30-day readmission rate for patients discharged from the hospital and returned to their primary care in a clinical office setting (21%) was higher than the national average readmission rate (17%). The high readmission rate suggested patients were receiving transitional care that was fragmented and non-standardized. Therefore, the implementation of a collaborative transition of care practice was vital to reduce avoidable readmissions.

PICOT: The PICOT question that guided this project was, “In adult patients with chronic conditions, what is the effect of a transition of care practice, versus a non-standardized practice, on reducing 30-day readmissions, within a …

Early Diagnosis Of Alzheimer’S Disease In The Primary Care Setting, Raymond R. Romano

Theses and Dissertations (ETD)

The burden of Alzheimer’s disease (AD) affects not just the individual but also families, providers, and society. Early recognition and diagnosis of AD may reduce cost by reducing interaction with the health care system, earlier initiation of treatment, and prolonging time to long- term care. Primary care providers, the first contact for diagnosis of patients with AD, are not fulfilling the potential of early diagnosis for a variety of reasons. Biomarkers of AD emerge on average 15 to 20 years before clinical diagnosis, yet currently established biomarkers are not easily available in the primary care setting. A growing body of …

The Impact Of Pre-Visit Contextual Data Collection On Patient Activation: Results From A Randomized Control Trial, Jeana Marie Holt

Theses and Dissertations

Background The majority of health indicators are outside of the healthcare system, and current electronic health records (EHR) do not capture those indicators. There is a compelling opportunity to test consumer informatics tools that integrate patient's life circumstances, goals, supports, risks, and care preferences into their EHR for point-of-care discussions.

Purpose To determine whether the use of a patient-generated contextual data (PCD) tool designed to enhance the capture and sharing of PCD influenced patient activation.

Design, Setting, and Participants A two-armed, non-blind, randomized control trial was conducted between May 2019, and October 2019 at two urban, academically affiliated primary care …

Implementing A Practice Strategy In Primary Care Using An Assessment Tool To Screen For Depression, Donna Snow

Doctoral Projects

Increased efforts are being made to move individuals with co-morbid medical and psychiatric diagnoses toward integrated care. Lack of consistent screening in primary care has caused missed opportunities to identify depression during a routine healthcare provider visit. This project sought to implement a practice strategy in primary care using an assessment tool to screen for depression. Interviews were used to ask patients to answer two questions related to the frequency of depressed mood in the last two weeks. The project was seeking to show by screening patients in primary care for depression, the number of referrals to behavioral health would …

Developing Lactation Support In A Primary Care Pediatric Office, Charlotte Minnema

Doctoral Projects

Background: Breast milk is known to be the best nutrition for infants, and experts recommend to exclusively breastfeed through the first six months of life and provide breastmilk through at least the first year of a child’s life (American Academy of Pediatrics, 2012). The United States is currently not achieving its breastfeeding goals set out in Healthy People 2020 by the US Department of Health and Human Services (U.S. Department of Health and Human Services, 2014). The integration of Internationally Board-Certified Lactation Consultants (IBCLC) into primary care pediatrics offices has been shown to increase all breastfeeding rates (Witt, Smith, Mason, …

Telehealth Visits For Common Concerns In A Primary Care Setting: Establishing A Protocol, Erin M. Leighton

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Barriers to accessing healthcare in Vermont include: weather conditions, rurality, lack of public transportation systems, and busy schedules. Telehealth mitigates these barriers, providing a safe and effective option on par with in-person visits, while lowering overall healthcare costs and increasing patient satisfaction. This project aimed to expand telehealth visits in a nurse practitioner-run primary care practice, via designing effective protocols and educating clinicians on telehealth use, requirements, documentation, and billing in order to complete telehealth visits successfully.

Methods: Infrastructure for telehealth: a workflow protocol, patient education materials, procurement of technological resources including iPads, and necessary, HIPAA compliant, secure accounts. …

Systematic Review: Barriers To Primary Care For The Transgender Individual, Charles David Mccormick

Walden Dissertations and Doctoral Studies

Representing a diverse group, the transgender community defies conventional norms expected by society resulting in discrimination and denial of essential goods and services necessary to maintain personal health, safety, and well being. The identification of the barriers to primary care faced by the transgender individual has the potential to reduce healthcare disparities and improve the compliance with national screening and treatment guidelines. The purpose of this project was to examine available literature incorporating the systematic review method to determine the barriers to primary care faced by the transgender individual. Using Leininger’s transcultural nursing theory to guide the process to determine …

Improving Provider Adherence To Guidelines And Screening For Adult Depression In Primary Care, Amber Crenshaw

Doctor of Nursing Practice

The purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, …

Provider Awareness Associated With Lifestyle Interventions And Adult Obesity, Reilly Tackett

Doctor of Nursing Practice Scholarly Project

The obesity epidemic cannot be solved through a single solution. A complex problem like obesity requires an intricately designed approach, comprised of both behavioral and environmental changes (Centers for Disease Control, 2015). Obese adults who attempt to alter their lifestyles often experience barriers to success. One such barrier is a provider who may be unfamiliar with evidence-based lifestyle interventions. Research suggests large variances both in provider knowledge levels and practice recommendations associated with adult obesity. This study’s purpose was; to determine if provider recommendations reflected clinical practice guidelines (CPG) associated with adult obesity, to measure current levels of provider knowledge, …

Adult Attention Deficit/Hyperactivity Disorder Quality Improvement Project, Danielle Miller

Doctoral Projects

Adults with Attention Deficit Hyperactivity Disorder (ADHD) vary widely in their symptom presentation and functional deficits, which can make management in the primary care setting challenging for providers (Morstedt, Corbisiero, Bitto, & Stieglitz, 2015). Measurement-based care is common in the management of medical disease, however is rarely used as standard practice in treatment of psychiatric disorders (Waldrop & McGuinness, 2017). As a result, treatment for psychiatric conditions, such as ADHD, may vary widely among clinicians and may result suboptimal treatment and patient outcomes (Waldrop & McGuinness, 2017). The proposed solution was to introduce the use of a standardized measurement tool …