Medicine and Health Sciences Commons^™

The Implementation Of Telehealth In Disease Management At Patient-Centered Medical Home, Mirsada Nurkanovic

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

Purpose: Telehealth (TH) and video conferencing in the patient-centered medical home (PCMH) can bridge geographical gaps between patients and providers, by eliminating the inconveniences of leaving the house and traveling to appointments. The evidence indicates that TH also: provides clinical benefits in high-risk patients¹, improves glucose control², improves quality of life and reduces ED visits and hospitalizations for patients with COPD³, enables self-care of patients with heart failure⁴, reduces risk of admission for patients with asthma⁵, improves medication adherence⁶, results in potential cost savings⁷, and provides …

Improving Palliative Care Management In The Nursing Home Setting: An Interprofessional Approach, Nicholas Adam Fredette

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

Purpose: Current projections indicate that the number of individuals age 65 and older throughout the U.S. will reach nearly 88 million by 2050, nearly double current estimates. With the increase in older adults, an increase in persons with chronic illness requiring nursing home care is also sure to rise. Currently, roughly 1.4 million adults reside in certified nursing facilities throughout the U.S. while nearly 25% of older adults die within this setting. Palliative care, an approach aimed at improving the quality of life of patients facing life-threatening illness is one strategy utilized to help manage this population. As the quality …

Responding To Adverse Childhood Experiences In The Primary Care Setting, Elsa M. Ingpen

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

Purpose. The impact of Adverse Childhood Experiences (ACEs) on lifelong health outcomes is well documented. The effects of ACEs can be mitigated using therapeutic and mindfulness strategies which build resilience. Many health care providers are reluctant to screen patients for ACEs, citing barriers such as time, lack of familiarity, concern for patient emotional stability, and lack of knowledge about resources for patients with high scores. This project was designed to address these barriers, develop a resource list for resiliency strategies, and create a sustainable screening model.

Methods. A rural Federally Qualified Health Center (FQHC) was chosen as the implementation …

Improving Diabetes Self-Management And Coordination Of Care Among Sash Participants, Meagan Goodwin

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

Introduction: SASH (Support and Services at Home) coordinates the resources of social service agencies, community health providers and nonprofit housing organizations to support Vermonters who choose to live independently at home. Currently, SASH does not have a way by which they monitor participant’s diabetes management. Aims of this project: 1. Improve diabetes management among SASH participants with a Diabetes Self-Management Tool; 2. Provide SASH Wellness nurses tools for education of newly diagnosed diabetics.

Methods: The Diabetes Self-Management tool documents aspects of the participant’s disease (blood pressure, blood glucose, A1C) and health goals. This was trialed in a small group of …

Assessing Need For Primary Care Services At A Needle Exchange Program: Safe Recovery, Catherine Hinojosa

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

Assessing Need for Primary Care Services at a Needle Exchange Program: Safe Recovery

Catherine Hinojosa

Purpose. Current estimates suggest that more than 15 million people worldwide inject drugs. Their mortality rate is 15 times higher than the general population, and despite their increased healthcare needs, their poor access to primary healthcare services is well documented. Providing primary care services within a harm reduction program, holds the potential to increase healthcare access in individuals who inject drugs. Anecdotal evidence exists that primary care services are desirable at Safe Recovery Needle Exchange Program. This study was designed to determine the feasibility …

Creating A Protocol For Patient Outreach At A Primary Care Clinic, Joshua D. Streeter

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

Purpose. The way that patient care is being delivered is evolving. One way in which this is happening is through patient centered medical homes (PCMH). PCMH represent a model of care that is accountable for meeting a patient’s care needs, including prevention and wellness, acute care and chronic care. To obtain status as a recognized PCMH, practices must fulfill specific quality care initiatives including patient outreach. Another way in which patient care is changing is through MACRA. This government initiative changes the way that practices are reimbursed for their services from fee-for-service to outcomes based measurements. Practices are now responsible …

Adhd Medication Protocols In The College Setting: A Standardized Student Provider Agreement, Alyssa Karges Turley

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

Purpose. Stimulant medication use and abuse is growing throughout the country, especially on college campuses. Diversion, through selling or giving of stimulant medication among college students is a common practice. Over half of college students currently taking a stimulant for Attention Deficit Hyperactive Disorder (ADHD) report diverting medication to a peer at least once. Reasons for misuse of stimulants include increased academic performance, increased attention, weight loss, and increased motivation. A standardized student provider agreement was needed for the student population at a small private college health center given a lack of clear expectations for the use of stimulants for …

Complementary And Alternative Therapies Education For High-Risk Women, Maya Ellen Carlet Dnp, Rn, L.Ac

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

Purpose. Women with substance use disorder (SUD) are considered high-risk and face many barriers accessing health care. One common barrier is distrust of the traditional medical model. Complementary and alternative medicine (CAM) provides these women an opportunity to build self-care skills and resiliency. This project was designed to address the complex healthcare needs of mothers with SUD by adding CAM modules to a current self-care skills curriculum.

Methods. To assess feasibility, a pilot program was created for a residential facility in Burlington, Vermont. The pilot program consisted of weekly 60 minute sessions over the course of 10 weeks. There …

Infant Safe Sleep: A Curriculum For Nurses On Labor And Delivery Units, Morgan Serke

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

Purpose. Approximately 3500 infants die annually in the United States from sleep related deaths. The American Academy of Pediatrics recommends a safe sleep environment that can reduce the risk of all sleep-related infant deaths. However, these recommendations are inconsistently adopted in communities and often rejected by parents. Studies have indicated that parents listen to nurses and model their actions regarding the sleep position of their new infant. The nurse’s behavior is essential in influencing parents to place their babies in a safe sleep environment, and staff education programs significantly increase the knowledge acquisition, attitudes, and practice intentions of these health …

Reducing Food Insecurity Amongst Vermont Children, Amy Denis

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

Reducing Food Insecurity Amongst Vermont Children

Purpose. In Vermont, one in five children suffers from hunger. Food insecure children are at risk for anemia, low bone density, increased hospitalizations, obesity and other chronic illness. Children living with food insecurity experience higher rates of depression, anxiety, behavioral dysregulation, cognitive delays, and even suicidal ideation. Clinical guidelines endorse screening during routine health maintenance visits. Cross-sectional studies demonstrate that only 15% of health care providers comply. The purpose of this project was to increase rates of food insecurity screening at a local private practice clinic, with the overall goal of reducing the …

Adapting The “Get Real” Curriculum: Improving Sexual Health In School Age Children, Jessica White

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

Adapting the "Get Real" Curriculum: Improving Sexual Health in School Age Children

Jessica L. White

Background: Vermont does not have standardized sexual health education. Curriculums such as “Get Real” have been shown to increase the age of sexual debut in middle school students and improve their relationships with parents. One barrier to implementing “Get Real” in Vermont is it has not been adapted to match the health proficiencies required by the Vermont Department of Education for students to graduate middle school.

Purpose: Increase buy-in of curriculum by Vermont school districts by applying proficiencies and adaptations to meet graduation criteria.

Methods: …

Disseminating Supplemental Screening Resources For Providers Counseling Women With Dense Breasts, Heejung J. Charron

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

Purpose.Vermont has a new mandatory breast density notification law that went into effect in January 2017. With the new legislation, mammographic density has a higher impact on patient management. However, 60% of facilities in states with a breast density notification law make no changes to their pre-existing practice concerning supplemental screening.Currently, there is no national consensus guideline available to aid with patient and provider decision-making regarding the recommendation of supplemental breast cancer screening for women with dense breasts. Patients should be properly counseled regarding the potential for false positive findings and the need for additional invasive procedures when pursuing …

An Evidence-Based Non-Opiate Withdrawal Treatment Protocol For Vermont Correctional Facilities, Kate J. Shaper

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

Purpose: The purpose of this project was to implement an improved standard of care for patients in acute opiate withdrawal in 6 correctional facilities using available evidence-based practice.

Methods: A comprehensive literature review of non-opiate interventions for acute opiate withdrawal (AOW) confirmed that clonidine effectively treats the objective symptoms, with lower risk for abuse and diversion. Additional supportive measures for AOW included hydroxyzine (Vistaril/Atarax), acetaminophen, and loperamide. Using these findings, a new medication protocol was formulated in partnership with the state medical director, the Department of Corrections, and the state director of nursing. An educational presentation regarding implementation and safety …

Simulation-Based Training To Increase Nursing Satisfaction, Timeliness, And Skills Acquisition, Rebecca Bent

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

Abstract

Purpose: Simulation based education for inpatient nurses is considered an effective teaching strategy and has been shown to increase nurse satisfaction, skills acquisition and positive patient outcomes. Nurses are highly satisfied with skills acquisition when performed in a simulation center and demonstrate improved skills performance. Simulation environments provide an ideal place for skills competency sign off as it is a place where mistakes can be made and learned from with no risk of harm to patients. A New England based 350 bed academic medical center (AMC) has consistently scored poorly on National Database of Nursing Quality Indicators surveys for …

Video Visits For Home Health Patients With Chronic Obstructive Pulmonary Disease, Anne Brereton

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

Purpose. Patients with Chronic Obstructive Pulmonary Disease (COPD) tend to face frequent emergency department visits and hospitalizations. The purpose of this project was to assist a home health agency in the process of building a video visit program to provide additional support to their COPD patient population.

Methods. A literature review was conducted to explore evidence for the use of video visits in home health care. Existing telehealth resources, a chart review, and interviews with stakeholders were utilized to create video visit guidelines. An online education module for staff was developed based off of the administration-approved guidelines. A post-module …

Designing A Teaching Nursing Home Model: Improving Education And Improving Care, Margaret Sara Aitken

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

Designing a Teaching Nursing Home Model: Improving education and improving care

Margaret Aitken

Purpose. The Teaching Nursing Home Model creates a partnership that melds clinical practice, student training, and academic nursing scholarship by creating an academic and clinical role for nurse practitioner faculty within a long term care and rehabilitation facility.

Methods. The literature was reviewed, with emphasis on prior utilization of the teaching nursing home model; current practices were investigated; key stakeholders met with and readiness for change assessed. Assessments were made of attitudes, logistics, and finances.

Methods. After a review of literature on teaching nursing home models, a …