Medicine and Health Sciences Commons^™

Self-Measured Blood Pressure Monitoring: A Patient Empowerment Project, Alison Cusmano

Doctor of Nursing Practice Final Manuscripts

Hypertension is a public health issue estimated to affect 112 million adults by 2030. Primary care patients in an outpatient clinic in Southern California with elevated blood pressure readings in the office did not have an organized system for close follow-up. The purpose of this evidence-based project (EBP) was to educate patients on self-measured blood pressure monitoring (SMBP), Dietary Approaches to Stop Hypertension (DASH), diet interventions, and healthy weight loss to improve hypertension rates. Through these interventions, patients developed an understanding of their systolic and diastolic blood pressure goals. Nurse practitioners, medical assistants, and licensed vocational nurses screened for high …

Deprescribing In The Hospice Population, Who Is Eligible And Who Is Agreeable: A Quality Improvement Project, Ashlee Nicole Smith

Doctor of Nursing Practice Final Manuscripts

Current evidence recommends and supports deprescribing medications to reduce polypharmacy in the hospice population. The project aim was to determine accurate percentages of deprescribing at three time periods: before hospice admission, at hospice enrollment, and four weeks post hospice enrollment. This project was a retrospective review of the medication administration record (MAR) of patients admitted into Sharp Hospice from a Sharp Healthcare facility. Sharp Hospice, in California, USA, admitted 164 patients during August 2020. Of those, 34 patients were eligible for inclusion in this retrospective quality improvement review. Prior to discharge from a Sharp facility, the percentage of target medications …

Telehealth Breastfeeding: Best Practice Guideline, Laura Amabile

Doctor of Nursing Practice Final Manuscripts

Background: Only 24.9% of United Stated infants are exclusively breastfed through six months. Healthy People 2020 breastfeeding goals include increasing the proportion of infant breastfed through six months to 60.6%. The Surgeon General’s Call to Action identified increasing access to International Board-Certified Lactation Consultants as a priority to improve breastfeeding percentages.

Purpose: Implementation of an evidence-based telehealth breastfeeding guideline, will provide mothers with consistent education regarding breastfeeding practices and guidance to overcome common obstacles, which will then result in increased confidence levels regarding breastfeeding and increase breastfeeding durations.

Study and Design: The Iowa model was utilized to guide this project. …

Bridging The Gap: Utilization Of Telehealth For Heart Failure Patients To Reduce Hospital Readmissions: Best Practice And Recommendations, Shalaine Corbilla

Doctor of Nursing Practice Final Manuscripts

Background: Heart failure is a leading cause of morbidity and mortality in the United States and accounts for a vast number of 30-day hospital readmissions. Within the first 30 days of discharge, patients and caregivers often misinterpret discharge instructions or lack access to providers. During this period, some modifiable symptoms become too difficult to tolerate and patients return to the emergency department for assessment and ultimately readmission for high-risk complications. The Sars-CoV-2 pandemic has added additional barriers for patients to receive care after a hospital discharge.

Purpose: To identify current best practices used for outpatient follow up with …

Management Of Mild Abscesses In Adult Patients, Liliana Pittman

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to improve the management of purulent skin and soft tissue infections (SSTIs) among male inmates incarcerated within a detention facility in Southern California. Standardizing the use of the Infectious Diseases of America (IDSA) guidelines could ensure improved management of mild abscesses. The IDSA guideline supported the use of incision and drainage of mild abscesses without the use of broad-spectrum antibiotics when clinically appropriate. Over the past decade, the emergence of multi-resistant pathogens has contributed to an increase in the incidence of SSTIs. In 2012, the total cost of SSTIs in the United States …

Achieving Advance Care Planning In Diverse Populations Via Teleconferencing With Skilled Nursing Facility Residents, Tania Huezo

Doctor of Nursing Practice Final Manuscripts

Background: Advance care planning (ACP) has always been a priority in healthcare, and even more crucial during the COVID-19 pandemic. It has been extremely challenging for ACP to occur in the skilled nursing facility (SNF) population once social distancing restrictions were put in place to protect residents and staff.

Purpose: The purpose of this evidence-based project was to assess the effectiveness of ACP via teleconferencing with skilled nursing facility (SNF) residents in the hope of increasing completion of high-quality Physician’s Orders for Life-Sustaining Treatment (POLST) forms.

Methods: The San Diego Coalition for Compassionate Care developed an ACP community outreach program …

Increasing Physical Activity In Children And Adolescents During The Covid-19 Pandemic, Alyssa Plisic

Doctor of Nursing Practice Final Manuscripts

Exercise benefits physical and mental health, prevents chronic disease, and improves overall quality of life. Most children and adolescents do not meet daily physical activity recommendations (Child and Adolescent Health Measurement Initiative, 2019). The COVID-19 pandemic created large barriers for engagement in exercise and further decreased levels of activity in this population (Dunton et al., 2020; Moore et al., 2020; Sekulic et al., 2020). This project evaluates the effects of the COVID-19 pandemic on physical activity in youth 8-17 years old. An exercise journal increased activity in all participants and promoted attention to daily activity. Overall activity and participation in …

Improving Pediatric Provider Preparedness For Postpartum Depression Screening, Samantha Shafer, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Background: Postpartum depression (PPD) is one of the most common complications of childbirth, affecting approximately 10-20% of mothers within the child’s first year of life with negative impact on both mother and child. . Pediatric primary care providers have frequent contact over the infant’s first year of life. The American Academy of Pediatrics (AAP) recommends screening mothers for PPD at the 1, 2, 4, and 6-month well-baby visits, yet due to barriers, pediatric providers are not consistently screening for PPD. Barriers include lack of preparedness and knowledge of resources and inadequate time.

Aims of Service Change: To improve pediatric provider …

Establishment Of Best Practice Skills For Advanced Practice Nurses, Leslie Kendrick, Tara Hughes, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Over the past two decades, nursing researchers have defined nurses’ perceptions of evidence-based practice as well as facilitators and barriers to its implementation . This project seeks to take the next step through a current assessment of registered and advanced-practice nurses’ assimilation of evidence-based practice as well as a current literature review of the research to clinical use gap. This is a cross-sectional, retrospective project. Through analysis of two self-administered questionnaires to both registered and advanced-practice clinical nurses as well as literature review findings, five recommendations for advanced-practice nurses were created. Ultimately, the goal of this project seeks to establish …

Get America Talking: Implementing Advanced Care Planning In Primary Care, Sasha Recht

Doctor of Nursing Practice Final Manuscripts

Advanced Care Planning (ACP) is an essential part of providing adequate care in the primary care setting. Discussing end of life with patients can be a tedious and uncomfortable conversation for many providers, however, its continued avoidance contributes to the stigma of end of life care and may also result in significant healthcare cost expenditure with the use of unwanted invasive treatments. All providers should engage in consistent advanced care planning in order to improve patient and provider communication, improve patient satisfaction, increase advanced directives on file, reduce the stigma of the topic, and improve quality of life.

Efficacy Of Telehealth Modalities In Medication Adherence For Older Adults, Mitchell Adrian C. Siy

Doctor of Nursing Practice Final Manuscripts

About half of the geriatric population who take at least one medication find medication adherence challenging. Average adherence of an elderly patient taking one medication a day is about 80%. This adherence decreases to about 50% for patients taking medications four times a day. Nonadherence can lead to a myriad of preventable adverse effects that can reduce the quality of life and even result in death. In the United States, $100-300 billion could be saved in health care costs due to adverse effects of poor medication adherence. The purpose of this evidence-based project (EBP) is to improve medication adherence in …

Improving Identification Of Seniors At Risk Tool Adherence To Identify Emergency Department Readmissions In Older Adults, Joy Gao

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project (EBP) is to improve the emergency department (E.D.) staff adherence in completing the Identifying Seniors at Risk (ISAR) screening tool. The specific aim is to improve electronic health record (EHR) data collection to enhance the identification of older adults that are frequent utilizers of the E.D. at a local community hospital in Southern California. Based upon the most recent National Hospital Ambulatory Medical Care Survey, patients ages 65 and older make up 32% of all E.D. admissions. These patients also represent 50% of the moderate to severely ill patients seen in the E.D. …

A Guide To Vaccine Policy Change At A National Level, Janelle Bird

Doctor of Nursing Practice Final Manuscripts

Abstract

Health policy is in a near constant state of improvement. In order to solidify those improvements, health policy requires assistance from the upcoming generations of healthcare workers to push for those changes. Due to the outdated vaccination policy in the American Nurses Association (ANA), many states continued to issue exemptions based upon unsupported religious preferences. This helped to worsen the outbreak of measles in 2018-2019. The Previous ANA Policy on Vaccinations as of July 21, 2015 stated the ANA supports immunization exemptions only for the following reasons: Medical contraindications and Religious beliefs. Educate and train future health care professionals …

Identifying Gaps In Follow-Up Care Among Adults In An Occupational Health Setting: A Retrospective Ebp Pilot, Ginny Meyerhuber, Msn, Rn

Doctor of Nursing Practice Final Manuscripts

The Aim of this Evidence-Based Project (EBP) was to find a gap in care among adults working in a large financial institution who had the presence of elevated blood pressure at an onsite health clinic visit in the previous 3 years. Background: Screening for elevated blood pressure in an occupational health setting identified adults with one of the most common chronic medical conditions. Additionally, almost one-half of all adults in the United States have hypertension (HTN); a preventable risk factor for strokes and heart disease (Office of the Surgeon General, 2020). This Surgeon General’s report revealed that HTN control …

Sunscreen Use And Screening In College Athletes: An Evidence-Based Pilot Project, Nicole Brustkern Bsn, Rn, Cpn, Sharon Boothe-Kepple Phd, Msn, Fnp-C, Phn (Chickasaw)

Doctor of Nursing Practice Final Manuscripts

Background: Melanoma is the third most common cancer in individuals ages 15 – 29. The greatest risk for melanoma is ultraviolet (UV) radiation from the sun. Collegiate athletes are exposed to 1,000 more sun hours per year than the average adult, placing them at higher risk for melanoma. Evidence supports sunscreen education and screening to promote protective behaviors in young adults.

Objective: This evidence-based pilot project implements the standardized screening of sunscreen use and sun protective behaviors in women’s soccer players ages 18 to 21 years old at the University of San Diego.

Methods: The Sun Exposure and Protection Index …

Implementation Of The Center For Disease Control (Cdc) Prediabetes Risk Test In The Medical Weight Loss Setting, Gabriela Miller, Rn, Bsn

Doctor of Nursing Practice Final Manuscripts

Background: Prediabetes is a serious health condition where blood sugars are higher than normal which increases risk of developing type 2 diabetes mellitus (T2DM), heart disease and stroke. One in three US adults have prediabetes and 90% of them do not know. Losing 5-7% of body weight and regular physical activity can lower the risk of developing T2DM by more than half.

Methods: Screening patients for prediabetes at a medical weight loss clinic using the evidence-based Centers for Disease Control (CDC) Prediabetes Risk Test. A score of five or higher on the screening tool indicates the patient is at risk …

Transitioning From Onsite To Online Psychotherapy Visits During The Covid-19 Crisis, Michael Angello Negron, Dnp

Doctor of Nursing Practice Final Manuscripts

Background: On March 19, 2020, the governor of the State of California, Gavin Newsom, issued executive stay-at-home order due to the coronavirus disease (COVID-19) pandemic (State of California, 2020). In a private psychiatric practice in southern California treating patients with anxiety and depression, psychotherapy treatment was abruptly affected by that order. The purpose of this project was to transition from onsite to online psychotherapy visits to ensure the continuity of care and facilitate patients’ progress in dealing with mental illnesses during the COVID-19 crisis.

Aims: The proposed solution to the problem of decreased access to care during the pandemic was …

Managing Pediatric Atopic Dermatitis In The Allergy Clinic: Use Of An Eczema Action Plan To Improve Caregiver Understanding And Self-Efficacy, A Pilot Study, Danielle Hubacek

Doctor of Nursing Practice Final Manuscripts

Eczema, or atopic dermatitis, is a complex and chronic condition that affects approximately 10% of children throughout the United States (Brown et al., 2018). The American Academy of Allergy Asthma & Immunology (AAAAI) (2017) estimates the average cost of eczema management for each patient is approximately $3,302 per year. The complex nature of atopic dermatitis indicates a need for individualized treatment plans. Research has shown that standardized patient teaching, written education materials, and Eczema Action Plans (EAP) reinforce patient teaching, parental understanding, and improve quality of life. This evidence-based practice (EBP) project introduces the use of a written Eczema Action …

Identifying Adverse Childhood Experiences (Aces) In A Federally Qualified Health Center Using The Pediatric Aces And Related Life Events Screener, Melody Albarran-Slovin, Bsn, Rn

Doctor of Nursing Practice Final Manuscripts

Background: Evidence links adverse childhood experiences (ACEs) to health issues later in life. Most research has been conducted in adults but there is a lack of recent research on the impact of ACEs in the pediatric population particularly in relation to mental health conditions. Utilizing the Pediatric ACEs Screener (PEARLS) health care providers can screen for ACEs at earlier ages.

Purpose: The aim of this evidence-based project is to determine if there is an increase of newly diagnosed mental health related disorders when using PEARLS compared to not using PEARLS in the previous months before implementation.

Methods: ACEs were identified …

Weight Reduction Motivation In Osteoarthritis Patients Through Nurse Practitioner Driven Education And Follow-Up: A Pilot Project, Caoilfhionn Mulvey, Martha Fuller Phd

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The ultimate goal of this short-term pilot project is for

overweight or obese osteoarthritis patients to increase their knowledge on the benefits of

weight loss and physical activity. Research shows that for every kilogram of weight lost,

2.2–4.0 kilograms of weight is taken off of the joint and could reduce joint pain up to

thirty to fifty percent and improve quality of life. Following education from the provider,

patients will understand the correlation of osteoarthritis symptom management with

weight loss.

EBP Model/Frameworks: This project utilizes the Iowa Model of Evidence-Based

Practice to Promote Quality Care. This addresses …

Balancing Provider Stress And Resilience In The Time Of Covid, Zachary Love

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project is to improve secondary traumatic stress (STS), compassion satisfaction, and burnout amongst providers—physicians, residents, and nurse practitioners—within the acute psychiatry units of the La Jolla Veterans Health Administration (VHA) through a one-time educational training session.

Background: Mental health providers at the VHA acute psychiatry units experience one of the highest risks for the development of STS, CF, and burnout amongst all professions due to a number of individual and institutional factors. STS is characterized by secondhand traumatization with symptoms similar to that of Post-Traumatic Stress Disorder—difficulty sleeping, mood changes, upsetting images appearing …

Sun Protection Behaviors In Patients With Actinic Keratosis, Madison Molotky

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to increase sun protection discussion and education in patients with actinic keratosis at a dermatology clinic. Actinic keratosis is one of the most common dermatologic diagnoses in patients 45 and older. Fifty-eight million Americans have one or more actinic keratoses and they are caused by years of UV sun exposure without sun protection. They are often a precursor to squamous cell carcinoma and adequate sun protection can prevent future lesions from developing and slow or stop the progression of current lesions. The Sun Exposure and Protection Index was implemented for patients with actinic keratosis …

Reducing Obesity Rates Among Adults In A Primary Care Setting: An Evidence-Based Practice Project, Raxita Neupane

Doctor of Nursing Practice Final Manuscripts

Background: Over 60% of adults in the United States meet the criteria for being overweight or obese. The estimated obesity-related health care costs are as high as $147 billion per year. Despite the alarming health risks and increasing health care costs, the rates of screening and counseling for obesity in the primary care setting are merely 30%. This project outlines weight-management counseling strategies.

Purpose of Project: The purpose of the evidence-based practice project was to implement patient-tailored evidence-based nutritional assessment tools and intensive behavioral counseling. The ultimate goal was to reduce body mass index (BMI) among overweight and obese …

Treatment Anxiety Education For Pediatric Cardiac Neurodevelopmental Patients, An Evidence Based Project, Mary Nagel

Doctor of Nursing Practice Final Manuscripts

Abstract

Background

Congenital heart disease (CHD) is the most common birth defect and affects almost 1% of all live births. Treatment anxiety is common among children with CHD who undergo multiple procedures early in their lifetime. Dramatically increased life spans for this cardiac population has led to a shift from focusing on survival to their long-term health outcomes.

Methods:

Administration of the Peds QL Cardiac Module 3.0 assesses health related quality of life (HRQOL) during annual visits to a Cardiac Neurodevelopmental (ND) Clinic by evaluating the level of Treatment Anxiety a patient experiences during healthcare appointments. The questionnaire scores are …

Implementing Ebp Guidelines To Optimize Human Donor Milk Usage In The Hospital Setting, Kimberly Carriker

Doctor of Nursing Practice Final Manuscripts

Purpose statement and rationale: The purpose of the project was to implement a donor milk workflow for an academic hospital so that babies who qualify for donor milk receive it instead of formula. It aimed to improve adherence to the protocol and increase the percentage of babies who received breast milk in the hospital setting and followed The Iowa Model for implementation.

Synthesis of evidence: Top regulating agencies and healthcare entities all support breastfeeding and breast milk use. Studies have been performed to address formula use versus human milk use in infants and show that babies have better outcomes when …

Substance Use Screening, Brief Intervention, And Referral To Treatment (Sbirt) In Pregnant Women Living With Hiv, Whitney Markowitz

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT) in Pregnant Women Living with Human Immunodeficiency Virus (HIV)

BACKGROUND: According to the 2018 National Survey on Drug Use and Health, 5.4%, 9.9%, and 11.1% of pregnant women reported use of illicit drugs, alcohol, and tobacco, respectively, in the past month. In the same year, Centers for Disease Control reported 19% of new HIV diagnoses were among women. Substance use in pregnant women living with HIV increases risk of adverse outcomes for both mother and child including neonatal viral transmission and obstetrical complications. Universal screening for substance use …

Family Bereavement Implications For Military Personnel: A Policy Proposal, Dehussa Urbieta

Doctor of Nursing Practice Final Manuscripts

Introduction: The death of a child is a devastating tragedy. Evidence demonstrates a link between bereavement and increased mortality risks and decrements in physical and mental health. Factors are compounded in active-duty service members through arduous duty environments, deployments, relocations, and inadequate support systems.

Methods: A focused literature search of bereavement specifically concentrated on child loss and the sequela on survivor mental health and functioning was conducted. The quality of the evidence was assessed using the Melnyk Evidence-Based Practice Model. The Evidence-Based Public Health Model was used as a guide for policy development.

Evidence-Based Intervention: Draft a military parental bereavement …

Preoperative Fasting Policy Updated For Healthy Patients, Janet Dewees

Doctor of Nursing Practice Final Manuscripts

Preoperative fasting of solids and liquids for 8 hours prior to surgeries requiring anesthesia has been the standard for decades. Guidelines developed in 1999 by the American Society of Anesthesiologists (ASA) allow clear liquids up to 2 hours prior to elective surgery in healthy patients. These guidelines were evaluated and endorsed by the ASA in 2011 and 2017. However, after two decades, this policy is still not standard in many facilities. This evidence-based project aims to change the current fasting policy at a surgery center in Southern California to allow clear liquids up to 2 hours prior to elective procedures …

The Second Victim: Knowledge For The Healthcare Team, Charisse Lyn Tabotabo

Doctor of Nursing Practice Final Manuscripts

Adverse patient events can have lasting and traumatic effects on members of the healthcare team. In 2019, a Southern California healthcare organization developed a peer support program for second victims (SVs). Despite this program being available to all staff, many nurses in the neonatal intensive care unit (NICU) of a metropolitan area entity did not know the program existed. The purpose of this study was to provide education to NICU nurses about second victims and the organization’s peer support program through an online learning module. Participants completed a survey upon module completion. The survey used a simultaneous pre-post survey on …

Motivational Interviewing And Frequent Follow-Up In A Pediatric Primary Care Setting To Improve Diet And Activity In Adolescents, Celeste Armenta, Kathy James

Doctor of Nursing Practice Final Manuscripts

Background: Adolescent obesity is a serious health concern with increased worldwide prevalence. Excess weight gain can affect adolescent’s physical and emotional health. The adolescent with excess weight can involve acute and chronic long-term health complications that continue into adulthood.

Methods: Health care providers screened for overweight and obese adolescents during annual physicals and follow-up visits. Thirty adolescents at the 85th - 95th percentile and above on the growth chart received a pre and post clinical-screening questionnaire for eating behaviors and exercise. Individualized education with parent involvement and motivational interviewing (MI) was implemented with monthly follow-ups for 4 months.

Findings: Data …