Medicine and Health Sciences Commons^™

Improving Lead Screening In A Pediatric Practice: A Quality Improvement Project, Audrey Myers

Doctor of Nursing Practice (DNP) Final Clinical Projects, 2016-2019

Abstract

Background: Detectable lead levels in children’s blood have been associated with increased cognitive difficulties, attention deficits, and poorer academic performance. Children enrolled in Medicaid have higher rates of elevated blood lead levels, yet requirements to test all children at age 1 and 2 who are enrolled in Medicaid are not being met. Nationally, 34% of children enrolled in Medicaid do not undergo proper blood lead level screening. The aim of this project was to increase required blood lead level screening rates for children with Medicaid insurance at a private pediatric practice in the Shenandoah Valley in Virginia.

Methods: The …

School-Based Suicide Prevention Program Implementation: Improving Awareness Among Parents And Faculty, Nicole Neuman

Doctor of Nursing Practice (DNP) Projects

The health development and critical transition period of preteen to adolescence are subject to adverse experiences and prevalent risk behaviors that may negatively influence mental health. Emerging issues of depression and suicide among school-aged youths present a global epidemic. Well-designed interventions, such as school-based programs, align with national strategies and health initiatives to reduce suicide rates and facilitate treatment of concerning symptoms. Database searches for school-based, suicide, depression, prevention, and screening literature from 2012-2017 identified 12 relevant studies selected for review. Mental wellness and suicide prevention curricula must successfully improve wisdom, enhance coping skills/resilience, and foster relationships which support help-seeking …

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

The Meaning Of A Family History Of Colorectal Cancer In Black Families In The United States, Cassandra Loggins

Dissertations

The purpose of this study is to understand the meaning of a family history of colorectal cancer (CRC) for first-degree relatives of Blacks diagnosed with CRC. Even though CRC is more preventable than other cancers because of effective screening tests for prevention and early detection, Blacks experience a disproportionate burden of CRC compared to other groups. Interventions to increase CRC screening among Blacks have not produced a significant reduction in CRC disparity. Underutilization of CRC screening and low perceived risk of CRC are major factors contributing to CRC disparity. The informing methodological approach employed in this study was hermeneutic phenomenology, …

Addressing Barriers To Medication Adherence: An Evidence-Based Screening Instrument Validation Study, Donna Jean Washburn

Doctoral Dissertations and Projects

Adherence to a prescribed medication regimen is often critical to successful disease management. Cancer diagnoses often further complicate control of the comorbid diseases. Older cancer patients with multiple comorbidities receiving chemotherapy treatment are at increased risk for adverse health outcomes from uncontrolled disease when nonadherent to their medication regimen. The intent of this pilot study was to test the validity of an evidence-based screening instrument designed to identify patients at risk for medication nonadherence and uncontrolled illness. The W-BMA (Washburn-Barrier to Medication Adherence) screening criteria were applied to retrospective data of cancer patients with multiple co-morbidities. SPSS was used to …

A Partnership Between Nursing Faculty, Students, And Urban Community Centers To Provide Vision Screenings For Low-Income Immigrant Women: An Experiential Case Study, Rose C. O'Halloran, Kerry A. Milner, Kim Foito

Sacred Heart University Scholar

Given the current health care climate, it is critical for nurse educators to provide learning opportunities for students to collaborate with leaders in the community to provide much-needed services to vulnerable populations. We developed, implemented, and evaluated a process for vision screenings and referrals to a local eye center for low-income, immigrant women over three years in an urban setting in the United States. This is a report on the program, including the challenges faced by the faculty and lessons learned by the nursing students.

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 …

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 …

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 …

Improving Adolescent Risk Assessment In A Primary Care Setting, Kristin N. Vanderwell

Doctoral Projects

Adolescent risk-taking behaviors contribute significant risk to the current and future health of adolescent patients and have a significant annual cost to society. A primary care practice in western Michigan had no standardized practice related to the screening, evaluation, and response to adolescent-risk taking behaviors. As a result, only three of the fourteen providers were consistently following national guidelines for screening, evaluating, and responding to adolescent risk-taking barriers. The providers cited lack of time and lack of knowledge as barriers to following guidelines. The purpose of this quality improvement project was to address the health care needs of the adolescent …

Colorectal Cancer Screening Education In Faith-Based Communities, Lindsay B. Medley 4811635, Lynette Smith, Marie Blankenship

International Journal of Faith Community Nursing

The principal intent for colorectal cancer screening is early detection and primary prevention of colorectal cancer. In spite of these intentions, there is a reluctance of the general population to participate in screening. Colorectal cancer is preventable. However, screening non-adherence contributes to both cancer mortality and incidence rates and results in expensive, unnecessary health care costs. A faith-based community nurse-driven educational session, using an American Cancer Society PowerPoint, was developed to address barriers of screening non-adherence. The educational session was offered to adults who participate in multiple faith-based organizations. The session provided education regarding colorectal cancer and colorectal cancer screening …

Implementation Of Evidence-Based Culturally Adapted Interventions, Collaborative Care, And Change Management For Improved Mental Health Outcomes In A Community-Based Safety-Net Clinic, Laura E. Hall

Doctoral Projects

Mental health disorders are prominent and devastating in the United States. They are more prevalent in low-socioeconomic and minority groups with lower rates of diagnosis and treatment in these populations. Primary care settings are the foremost location for screening, diagnosis, and treatment for common mental health disorders but do not always provide adequate care due to limitations of time, knowledge, and resources. Evidence has shown that collaborative care models can provide more effective treatment for behavioral health services through a team-based approach to holistic patient care. This project focused on implementing culturally adapted, collaborative care models to improve mental health …

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 …

Colorectal Cancer Awareness And Screening Guideline For African American Populations, Keyna Omenukor

Walden Dissertations and Doctoral Studies

Colorectal cancer is the 3rd leading cause of cancer-related deaths. Early screening

provides the best prospects for preventing the morbidity and mortality associated with the

disease. Nurses have the duty to promote health and prevent diseases. However, low rates

of colorectal cancer screening continue to be reported, especially among African

Americans who continue to suffer disproportionately from the disease. There is a need for

a culturally-sensitive clinical practice guideline that nurses can use to educate patients

appropriately on colorectal cancer. The practice focused question for this project was

designed to explore whether a culturally-sensitive clinical practice guideline to increase

colorectal …

Screening For Traumatic Brain Injuries (Tbi) In Veterans: A Quality Improvement Project To Change The Identification And Referral Process In Primary Care Providers., Chiara Simonini

Doctor of Nursing Practice (DNP) Projects

Background: The incidence of traumatic brain injuries (TBI) among veterans has increased exponentially in those who served in Operation Enduring Freedom and Operation Iraqi Freedom. Identification and treatment for these injuries remains difficult due to variance in screening methods, interpretation of results, and barriers to access to care. Purpose: The goal of this quality improvement project is to improve TBI screening process offered to veterans by healthcare workers and providers in an outpatient VA clinic in the northeast. Methods: Current standards of practice and provider knowledge were assessed through focus groups, pre-intervention survey, followed by educational outreach to provide …

A Quality Improvement Project To Improve Type 2 Diabetes Mellitus Screening In Asian Americans Using Body Mass Index Cut Point Of 23, Annie Samuel

Doctor of Nursing Practice (DNP) Projects

Background: Asian Americans are at a higher risk for Type II Diabetes than other groups and disproportionately develop Type II Diabetes Mellitus at younger ages, although having a lower Body Mass Index (BMI) compared to non-Hispanic whites.

Methods: A group of 22 Nurse Practitioners (NP) in New York were presented an evidence-based educational intervention along with a five-item pre-test and post-test to determine if they had acquired new knowledge on the issue. A follow-up survey was conducted to test if the intervention changed individual NP practice in screening Asian Americans in adult primary care clinics.

Results: The overall mean …

Managing Patients At High-Risk For Breast Cancer: An Elearning Module For Primary Care Providers, Erin Chaney

Doctor of Nursing Practice (DNP) Projects

Women at high-risk of developing breast cancer must be screened appropriately and educated about breast cancer reduction strategies much earlier than those of average risk. The National Comprehensive Cancer Network (NCCN) (2017) has identified guidelines for the care of this group. This project focused on the development of education for providers, specifically an eLearning module, to help translate guidelines into practice. Providers of adult primary care (including internal medicine and family practice) from four clinics in Snohomish County, Washington, were asked to participate in an eLearning module regarding the care of patients at high-risk for breast cancer. Repeated measures surveys …

Assessment Of An Educational Intervention To Increase Knowledge And Intention To Take Hpv Vaccine And Cervical Cancer Screening In Nigeria, Chigozie Anastacia Nkwonta

Theses and Dissertations

Nigeria has some of the highest rates of cervical cancer morbidity and mortality in sub-Saharan Africa. Both the human papillomavirus vaccine (HPV) and cervical screening are effective prevention strategies against both HPV infection and cervical cancer. Lack of awareness, limited knowledge, limited decision-making agency, lack of spousal support and stigma are barriers to uptake of these preventive measures. Given patriarchal structures and norms through which men control family resources and dominate decisions, male involvement in initiatives aimed at improving sexual and reproductive health is necessary. Community-based health education is an effective intervention to improve knowledge and reduce stigma. The aim …

The Effectiveness Of Screening For Comorbid Depression Among Outpatients With Chronic Diseases In Maryland, Linda Hasssan Allibalogun

Walden Dissertations and Doctoral Studies

Depression is a pervasive mental health disorder worldwide. Although being diagnosed with chronic illness exacerbates susceptibility to depression, detection and subsequent treatment of comorbid depression in primary care settings remain suboptimal because patients with chronic medical disorders are not commonly screened for depression. There is a need to initiate proactive measures by implementing routine screening in primary care settings. The plan-do-study-act (PDSA) model guided an intervention to establish a depression screening practice. This study aimed to determine if the implementation of evidence-based screening for depression using the Patient Health Questionnaire-9 (PHQ-9) tool could increase diagnosis of comorbid depression among patients …

Increasing The Value Of Medicare Annual Wellness Visits For Patients And Providers, Stephanie Hope Turner

Walden Dissertations and Doctoral Studies

The Medicare Annual Wellness Visit (AWV) has been available to Medicare beneficiaries since 2005; however, most eligible individuals have not taken advantage of this benefit. The literature supports that patients are willing to schedule and complete an AWV if urged to do so by their primary care provider; however, providers are reluctant to advise patients to pursue the AWV due to the lack of perceived value and overall health benefit. The integrative theory of health behavior change was used as the theoretical framework for the project. By increasing patient self-management skills through education, engagement, and support, the project was designed …

Korean Immigrant Women's Perceptions Of Cervical Cancer Screening In Hawaii, Eurina Yujin Cha

Walden Dissertations and Doctoral Studies

Minority immigrant women are more likely to be diagnosed with and suffer from cervical cancer compared to other minority women in the United States. The purpose of this qualitative ethnographic study was to explore cultural health perceptions, behaviors, and barriers to cervical cancer prevention among Korean immigrant women (KIW) in Hawaii. The health belief model and the social-ecological model were used to guide the study. Data were collected using individual structured interviews with 20 KIW ages 21 to 65 who are first-generation KIW immigrant to Hawaii. Data were coded and analyzed to identify themes. Findings revealed that participants (a) prefer …

Implementation Of The Stop Bang Screening Instrument For Obstructive Sleep Apnea Within The Intensive Care Unit And 5 East Cardiac Unit, Michael T. Lush

DNP Projects

BACKGROUND: Recent studies have found that OSA without the use of CPAP is an independent risk factor for cardiovascular disease and hypertension, which can lead to myocardial infarction (MI) and cerebral vascular accident (CVA) or stroke. This increases patient morbidity and mortality rates as well as medical costs. In those suffering from a myocardial infarction (MI) or cardiovascular accident (CVA), an important intervention is proper screening for the presence of OSA while in the acute care setting. The STOP BANG screening instrument is a simple yet effective tool in assessing for sleep apnea symptoms with a respective sensitivity of 93% …

Dyslipidemia Screening In Children Between The Ages Of 9 And 11 Years: An Evidence-Based Approach, Meredith Toms

DNP Projects

PURPOSE: The purpose of this study is to examine the outcome of healthcare provider education on the incidence of dyslipidemia screening in a pediatric primary care clinic.

METHODS: The design of this study was a descriptive pre and post design to evaluate if dyslipidemia screening rates, knowledge, and self-efficacy of healthcare providers changed following an education series at a general pediatric clinic in Lexington, KY. The rates of dyslipidemia screening were calculated prior to providing provider education as well as afterwards to see whether there was an improvement in screening rates. Provider’s knowledge and confidence before the education series was …

Evaluating The Effect Of A Nurse Navigator In Increasing Colorectal Screening, Christine Njogu

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a nurse navigator in increasing colorectal (CRC) screening in primary care setting.

METHODS: This was a descriptive retrospective study of the effect of nurse navigators in increasing colorectal screening in primary care settings within Jefferson county and its surrounding counties. The sample consisted of 200 patient chart reviews for the period of September 1st through December 31st, 2017. Rates of colorectal screening were compared in those who received a nurse navigator call and those who did not.

RESULTS: Overall screening rates were 44.6%. A distinct increase in screening …