Medicine and Health Sciences Commons^™

Evidence-Based Strategies For Reducing Post-Discharge Hospital E.R. Visits And Patient Initiated Calls In The Post Craniotomy Population, Homira Feely

Doctor of Nursing Practice Final Manuscripts

Evidence-based Strategies for Reducing Post-discharge E.R. Visits and Patient Initiated Calls in the post Craniotomy Population

Homira Feely, NP

Katherine Curran, BSN

Joseph Burkard, DNSc, CRNA

University of San Diego

OBJECTIVE

Health-care professionals are generally compassionate and well-meaning, but the infrastructure in which they function often has made the continuum of care between hospitals, outpatient settings and patients’ homes far from seamless. The result is a persistently high rate of emergency room visits and hospital readmissions within 30 days of a patient’s discharge – an avoidable pattern that has cost the U.S. health system tens of billions of dollars over …

A Common Goal: Primary Care And Psychiatry Improve Depression Detection And Outcomes, Katherine Kilkenny

Doctor of Nursing Practice Final Manuscripts

Background: Major Depressive Disorder (MDD) affects over 15 million (6.7%) adult Americans. While one in four primary care patients suffer from depressive symptoms, MDD is accurately diagnosed as little as 25% of the time.

Purpose: Implementation of an evidence-based protocol outlining the process for screening, behavioral health referral, and the role of a collaborative care team would improve detection and treatment of adult MDD patients in the ambulatory setting.

Process: A systematic Patient Health Questionnaire (PHQ-9) based screening protocol was implemented. Every new and existing patient completed the PHQ-9 during scheduled primary care appointments. If a patient scored 15 or …

In Honor Of Self: A Weight Loss Project For A Military Population With Mental Disorders, Tanya Denise Stevenson-Gaines

Doctor of Nursing Practice Final Manuscripts

Background: Obesity in people diagnosed with mental disorders is at an epidemic level. Individuals with a mental illness who are prescribed medication for stability are at risk for obesity and metabolic syndrome. People with mental disorders have a 10 to 30-year decrease in life expectancy associated with chronic illnesses. Military personnel are separated from service when they are measured outside of body composition assessment standards.

Aims: To address the problem of obesity in military members by providing a weight loss program with structured and collaborative weight management education and telephonic coaching.

Methods: Stakeholders were informed about the purpose and goals …

Management Of Chronic Low Back Pain With A Nonpharmacological Pain Management Kit Among Military Personnel, Heidi M. Sterling Bsn, Rn, Dnp Student, Karen A. Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Robert Topp Phd, Rn

Doctor of Nursing Practice Final Manuscripts

Background & Purpose:Low back pain is the second leading cause of disability in the United States, affecting 17% of Americans. Chronic low back pain (CLBP) is particularly debilitating among professions such as active duty military personnel (ADMP) who are required to maintain military readiness without the assistance of opioids. This scenario can result in individuals enduring untreated pain or resigning from participation in their unit. The purpose of this project is to determine the effect of providing a nonpharmacological pain management kit (NPMK) on pain and functional ability among ADMP who report CLBP.

Study Design:ADMP who suffer from CLBP were …

Optimizing Chronic Pain Management: Self-Care Utilization Among Veterans With Post-Traumatic Stress Disorder, Paul Krug, Anamarie J. Lazo, Joseph Burkard, David Bittleman

Doctor of Nursing Practice Final Manuscripts

Purpose: To implement a chronic pain management regimen that utilizes a self-care approach, integrating all dimensions of the biopsychosocial model to optimally treat the complex needs of younger Veterans with comorbid PTSD and chronic pain. The project aims to provide more insight and knowledge on safer chronic pain management among Veterans, reflected by improvement in patient’s pain level, quality of life, and depression scale.

Design: The project was implemented at the ASPIRE Center, a domiciliary residential rehabilitation treatment program for Veterans who suffer from PTSD and traumatic brain injury. The 5A’s behavior change model was utilized during clinic …

Stop, Meditate, And Listen: A Treatment Modality For Iraqi Refugees With Depression, Katherine Goehring

Doctor of Nursing Practice Final Manuscripts

Purposes: To implement a mindfulness meditation program with Arabic speaking clients as an adjunctive treatment of depression

Background: Depression rates among Iraqi refugees are between 28.3 and 75% compared to 8.6% in the general population (Slewa-Younan, Guajardo, Heriseanu, & Hasan, 2015). Treatment options are limited at Neighborhood Healthcare in El Cajon due to budget limitations, cultural beliefs and language barriers, among other reasons. Individual therapy is intended to be a brief intervention due to limited staffing. Many middle eastern refugees decline group therapy due to stigma surrounding mental health treatment and concerns about privacy. Even though traditional treatment …

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 …

Improving Quality Of Life In Veterans With Chronic Pain Through Patient Engagement, Linda Nyagaya

Doctor of Nursing Practice Final Manuscripts

Background: Various psychosocial factors affect follow up care among veterans with chronic pain. Engaging veterans by giving them the choice to decide contact modality for after clinic visit increases likelihood of successfully reaching patient and adherence to recommended pain management.

Purpose: To engage veterans through self-determined effective communication method: telephone, email or Myhealthevet for follow up care. The intervention aims to improve chronic pain self-care by assessing number of medications used for pain, numeric pain rating and quality of life score.

Framework/EBP Model: The Iowa Model and 5A’s will guide implementation and assessment of this project. Patients will self-determine the …

Prevention Of Functional Decline In Hospitalized Geriatric Patients: An Evidence-Based Mobility Pilot Project On An Acute Care Elderly (Ace) Unit, Hannah Grushkowsky

Doctor of Nursing Practice Final Manuscripts

Problem: Functional decline is the leading complication of hospitalization in the elderly. Loss of functional independence during hospitalization results from the inability to maintain function during hospitalization compounded by acute illness. Potential negative outcomes from decreased function include increased length of stay (LOS), morbidity, and added discharges to a skilled nursing facilities (SNF).

Introduction: A mobility-based protocol created by an interdisciplinary team was implemented for three months on an 8 to 12-bed specialized Acute Care Elderly (ACE) medical-surgical floor. The purpose of the project was to evaluate if an evidence-based practice (EBP) mobility protocol can decrease discharges to SNFs, falls, …

Family Nurse Practitioner Student Competencies In Integrated Psychiatric Healthcare, Mark Manning

Doctor of Nursing Practice Final Manuscripts

Title: Practicum to Practice: Family Nurse Practitioner Student Competencies in Integrated Psychiatric Mental Healthcare.

Background: Major Depressive Disorder (MDD) is a widespread and costly diagnosis that affects nearly 16 million people annually and costs the United States nearly $83 Billion. Primary care providers such as Family Nurse Practitioners (FNP) play a crucial role in screening for health problems, preventing, and managing illness. Opportunities exist to integrate psychiatric mental healthcare into FNP curriculum and clinical practicums to better prepare providers to identify and screen for depression.

Purpose: The purpose of this evidenced-based practice project is to evaluate FNP student competencies …

Reducing Pediatric Asthma Visits In The Emergency Department, Kathleen Grimley Ahn

Doctor of Nursing Practice Final Manuscripts

Purpose/Aims: The purpose of this project was to reduce the number of unnecessary pediatric asthma management visits to an urban emergency department (ED) by performing a brief action plan for improved National Heart, Lung, and Blood Institute (NHLBI) guideline adherence. This plan was shared with parents during an NP-initiated follow-up phone call.

Rationale/Background: Inadequate outpatient management of pediatric asthma can result in avoidable visits to the ED. Acute exacerbations comprise a large portion of pediatric asthma patients seeking care in the ED. Reasons for persistent under-utilization of outpatient care for asthma management in primary care settings are multifactorial. Daily symptom …

The Weight Of A Healthy Home: Early Screening For Childhood Obesity Risk, Sara Herbenick, Kathy James, Dnsc, Aprn, Faan, Jill Milton, Msn, Fnp

Doctor of Nursing Practice Final Manuscripts

Purpose

Despite the Healthy People 2020 target of 14.5%, the California obesity prevalence among low-income children ages 2 to 19 was 21% in 2010. An obesogenic home environment is a major contributor to overeating and sedentariness during this phase of development as children have less autonomy and are influenced by family environmental cues. The purpose of this evidence-based project was to implement a screening tool at a low socioeconomic elementary school clinic to identify children at risk of developing obesity and provide standardization for practitioners on educating parents regarding child obesity risk factors. The Family Nutrition and Physical Activity (FNPA) …

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 …

Diabetes Self Management Education In An Underserved Primary Care Setting, Jessica Salas

Doctor of Nursing Practice Final Manuscripts

Objective: A key component to the management of type 2 diabetes is appropriate self management of the disease by the patient. The purpose of this project was to provide culturally appropriate Diabetes Self Management Education in an underserved primary care setting to improve glycemic control among Spanish speaking patients who have uncontrolled diabetes.

Research Design and Methods: The evidence based practice project took place at a primary care practice in an underserved area. Fifteen Spanish speaking patients with uncontrolled type 2 diabetes with a hemoglobin A1c greater than 7% were included in the intervention. The intervention included implementation of Diabetes …

Power To The Patients: A Heart Failure Transitions Of Care Program In A Heart Resource Center, Katherine Nicole Oxina Padiernos Bsn, Rn, Dnp Student, Scot Nolan Dnp, Rn, Cns, Ccrn, Teri Armour -Burton Phd, Cnml, Ne-Bc, Colleen Austel Nadeau Bsn, Rn, Chfn

Doctor of Nursing Practice Final Manuscripts

Background: In the United States an estimated 5.7 million adults have heart failure (HF), costing $30.7 billion annually. National HF readmission rates have remained high at 21.3%. After an extensive literature review, the purpose of this project was to incorporate teach back methods, self care education, resource accessibility, and increased post-discharge contact through an outpatient heart failure transitions of care program.

Methods and Results: Prior to discharge, HF patients were recruited and given a pre-test Self Care of Heart Failure Index (SCHFI). A DNP student and progressive care unit registered nurses provided discharge education utilizing a Healthy Heart Tracker booklet …

Focus On Fitness: Incorporating Exercise Into The Treatment Of Children And Adolescents With Attention-Deficit Hyperactivity Disorder, Kristin Lulich

Doctor of Nursing Practice Final Manuscripts

Background: Psychotropic medications, particularly stimulants are frequently used as the first-line treatment for Attention Deficit Hyperactivity Disorder (ADHD). Many patients and their caregivers have concerns about psychotropic options for treatment. Review of current literature demonstrates the efficacy of physical activity in reducing symptoms of ADHD. Purpose: This evidence based practice (EBP) project introduced regular, scheduled aerobic activity into the treatment plan of children and adolescents with ADHD. The aim of this EBP was to reduce symptoms of ADHD measured by caregivers using the Vanderbilt Ratings Scale. The Johns Hopkins Nursing Evidence Based Practice Model was used to implement this project. …

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 …

Increasing Follow-Up In College Students With Latent Tuberculosis Infection, Emily Middleton, Dnp, Aprn, Ccrn, Kathy James, Dnsc, Aprn, Faan, Kimberly Woodruff, Md, Mph

Doctor of Nursing Practice Final Manuscripts

Around 13 million people in the United States have latent tuberculosis infection (LTBI) with a 5-10% chance of developing active tuberculosis (TB) in their lifetime if not treated (Center for Disease Control, 2015). At a University Student Health Center (SHC), there is a matriculation requirement for TB testing for students that screen as high risk. Many students have these testing requirements performed at outside clinics, including foreign clinics, and follow-up regarding education about LTBI and treatment recommendations was often missing. The purpose of this evidence-based practice (EBP) project was to increase follow-up, education, and treatment options after diagnosis of LTBI. …

Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to improve the medical screening process, enhance medical decision-making, and standardized the utilization of an adult traumatic brain injury neuroimaging guideline among advanced practice providers in a rural emergency department. Neuroimaging, specifically computed tomography (CT) scans, help to identify life-threatening intracranial injuries when clinically appropriate. The literature supports the utilization of neuroimaging guidelines, clinical exam, and provider expertise when identifying the need for a head CT scan. Although head CT scans are clinically useful, they increase healthcare costs and pose potential cancer risks from radiation exposure. Eight advanced practice providers (i.e., nurse practitioners, …