The Life-Saving Drug That No One Knows About: Naloxone Education And The Health Belief Model, Sarah Tilford

Undergraduate Honors Theses

Naloxone hydrochloride, popularly known by the brand name Narcan, is an emergency treatment used to reverse an overdose on opioid drugs. The CDC reports upwards of 26,000 individuals saved by naloxone between 1996 and 2014 (Centers for Disease Control and Prevention, 2015). Despite this success rate, those outside of the medical field largely remain unaware of what naloxone is or how they can use it in an emergency, leading to needless loss of life. Many studies focusing on naloxone access and education have been unable to offer findings meant to increase the use and ownership of the drug by lay …

Chronic Pain, Sleep Disruption, And Work Performance In The Military, Jeffrey Ransom

Dissertations

Abstract

Background and Significance: Managing pain is a challenge for many organizations, including the U.S. military. The added complication of managing sleep disruption compounds the issue. Examining pain and sleep disruption in the context of work performance within the military is critical to understanding the impact of these conditions on our nation’s fighting forces.

Purpose: Examine the associations of chronic pain and sleep disruption in the context of work performance among active duty military service members.

Research Aims: 1) Describe sociodemographic characteristics, military service characteristics, clinical characteristics, and work performance of active duty service members, 2) Examine relationships between these …

Effects Of Standardized Self-Care Behavior Education On Self-Efficacy Outcomes In Type Ii Diabetes Mellitus, Nishita Patolia Bsn, Rn, Dnp Student

Doctor of Nursing Practice Final Manuscripts

An evidence-based practice (EBP) project was implemented in a primary care setting to decrease Hemoglobin A1c (HgbA1c) levels and increase self-efficacy in Type II Diabetes Mellitus (T2DM) diagnosed individuals. According to the Centers for Disease Control (CDC), 30.3 million adults have diabetes in the United States, and one in four do not know they have it (CDC, 2017). It is a disease that can be managed and reversed with standardized self-management education. Self-management interventions can improve diabetes knowledge and encourage patient participation in caring for their health (Flode, Iversen, Aarflot, & Haltbakk, 2017).

The purpose of this evidence-based project was …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Nienke Sahelijo Bsn, Rn, Dnp-Fnp Student, Kori Fitzgerald Dnp, Fnp-C, Joseph F. Burkard Dncs, Crna

Doctor of Nursing Practice Final Manuscripts

Objectives: Palliative care services constitute a vital part of the oncology treatment plan. Much of the suffering associated directly with cancer itself or as a result of treatments can be mitigated with the early incorporation of palliative services. Unfortunately, access to palliative care remains elusive due to a lack of qualified providers. This evidence-based project was implemented in an effort to address gaps in care for advanced cancer patients. The goal was to provide telehealth visits for follow-up of stable patients to manage symptoms and psychosocial challenges with equivalent or improved satisfaction as compared to their last in-office visit …

Improving Latent Tuberculosis Infection (Ltbi) Screening And Treatment In A School-Based Setting, Andrea Bell

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: San Diego County’s tuberculosis (TB) incidence rate is nearly double than the national rate. In 2019, there have been 5 cases of active TB in the county’s public high schools, which have demonstrated the need for prevention interventions in this setting.

Objectives: This evidence-based project is aimed to increase awareness, screening and treatment of latent TB infection (LTBI) in the school setting.

Methods: A TB risk assessment form and consent was sent in the registration packets. A one-time TB educational presentation was given to high school freshman students with a pretest and posttest. For students at-risk, a confidential …

Enhancing Chronic Pain Management: Motivational Interview Among Lower Back Patients –Phase Ii, Valerie Gates, Melissa Hines-Antico

Doctor of Nursing Practice Final Manuscripts

Purpose: Chronic low back pain in adults is difficult to manage and can lead to clinical, psychological, and social consequences. Providers often have restricted clinic time that prevents patient education regarding self-care and non-pharmacological therapies.

Design: This nurse practitioner-led, evidence-based project incorporates monthly telephone calls to improve patient pain, enhance quality of life, decrease opioid usage, increase physical activity, and promote the utilization of non-pharmacological multimodal therapies.

Methods: Implementing a monthly telephone call utilizing motivational interviewing and a 5 A’s guided questionnaire assisted in providing individualized treatment plans. Data outcomes include pain scores, quality of life scores, number of opioid …

Insulin Injection Re-Education For Improved Glycemic Control, Daniela Shon

Doctor of Nursing Practice Final Manuscripts

Title: Insulin Injection Re-education for Improved Glycemic Control

Background: Patients on insulin therapy often continue to show suboptimal glycemic control. Data from adult patients with T2DM have demonstrated that 56.1% had poor control, despite adherence to treatment, oral and injectable. Poor glycemic control stems from many sources, including poor self-efficacy regarding insulin dosage adjustment, inaccurate insulin dosing, expired insulin, lipohypertrophy of the injection site and technique, and equipment issues.

Purpose: This project aimed to implement and assess the efficacy of re-education in the insulin injection technique for improved glycemic control.

Methods: This project was conducted based on …

Veteran Specific Risk Factors For Delirium, Allison Perkins

Dissertations

Purpose/Aims: This study explored the relationships between military characteristics such as combat experience, mental health issues such as post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety and substance use disorder (SUD), physical comorbidities such as coronary artery disease (CAD), other risk factors, and delirium diagnosis among hospitalized veterans.

Background: Delirium is a common disorder experienced by 25% of all hospitalized adults 65 years and older. No published studies to date have examined whether combat, TBI and PTSD are associated with the incidence of delirium in the hospitalized veteran.

Methods: A retrospective cross-sectional cohort design with a sample size …

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

Audiocommunicator Reminder Phone Calls To Increase Attendance Of Well Child Visits, Taylor L. Wisner Barojas, Martha G. Fuller, Alison M. Schurman

Doctor of Nursing Practice Final Manuscripts

Background: The American Academy of Pediatrics recommends six well child checks (WCC) between 2 to 15 months. A large pediatric clinic in Southern California has an attendance rate of 86% and a very mobile population. Reminder phone calls have been shown to improve WCC attendance.

Aims of Service Change: Improve WCC attendance to >90%. As an interim step, we implemented a pilot project and measured responses to AudioCOMMUNICATOR™ reminder calls.

Outcome: In two months 148 calls were made, the majority,74%, went unanswered. 26% were able to schedule an appointment or discharge from the clinic.

Discussion: Reminder calls provide a simple …

Reducing The Rate Of Falls In Hospice Patients: A Fall Prevention Pilot Program, Allison Floyd

Doctor of Nursing Practice Final Manuscripts

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics …

It's More Than Just "Baby Blues" - Screening For Postpartum Depression In A Pediatric Setting, Breanna M. Lazar, Martha G. Fuller

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Postpartum depression (PPD) is estimated to affect up to 1 out of 7 women. Evidence and American Academy of Pediatrics (AAP) guidelines support maternal screening for PPD in a pediatric setting during well-child visits. The pediatric office is frequently visited during the first year of life and is a suitable setting to perform screening.

Aims of Service Change: Implement AAP recommended PPD screening at a busy primary care practice in Southern California using the Patient Health Questionnaire (PHQ-9).

Details of Innovation: In this pilot project, mothers (who were not patients of the pediatric practice) consented to be screened …

Eating For Two Without Eating Too Much: Optimizing Gestational Weight Gain, Sandra Pope

Doctor of Nursing Practice Final Manuscripts

This evidence-based pilot project was implemented to optimize gestational weight gain (GWG) among women enrolled for prenatal care at a private practice. Evidence from meta-analyses and large studies show: 1) an association between excess GWG and increased risk of fetal macrosomia and increased cesarean delivery; 2) 66% of women do not know their healthy GWG target; 3) a 20% reduction in excess GWG in women receiving diet or exercise interventions or both. In addition, visual plotting of weight gain has helped overweight adults reduce and maintain weight loss over a one-year period. Nutrition assessment using a validated nutritional screening questionnaire …

Screening For Post-Menopausal Osteoporosis In Women Ages 30-64 Review Of A Pilot Program In Primary Carescreening For Post-Menopausal Osteoporosis In Women Ages 30-64 Review Of A Pilot Program In Primary Care, Elaine Henson

Doctor of Nursing Practice Final Manuscripts

The risk of an osteoporotic hip fracture is greater than the combined risks of breast cancer, myocardial infarction, and stroke, yet research shows less than 25% of women are being screened. Post-menopause, either surgical or natural, is a risk factor for osteoporosis. Nurse practitioners are in an excellent position to lead the way in osteoporosis screening. This article presents findings in a recent osteoporosis screening program in a primary care office.

Calm: A Mindfulness Mobile App For Stress Reduction In The Workplace, Gizzele Valencia

Doctor of Nursing Practice Final Manuscripts

This evidence-based pilot (EBP) project was implemented to decrease stress among employees who work in a financial-based occupational health setting. According to the American Psychological Association’s (APA) Stress in America online survey, 64% of survey-respondents reported that work is a significant source of stress (2018). Mindfulness meditation is a spiritual practice that helps a person acknowledge how to experience emotions and events without judgment (Luken & Sammons, 2016). A mobile app-guided mindfulness program could reduce perceived stress and increase mindfulness levels. These practices might improve work productivity, decision-making skills, organizational relationships, self-care, and perspective taking development (Jayawardene, Lohrmann, Erbe, & …

Utilization Of Peer-Led Education To Enhance Advance Care Planning And Advance Directive Completion, Jenna Juenger

Doctor of Nursing Practice Final Manuscripts

Background: The integration of advance care planning (ACP) and palliative care (PC) into oncology plays a critical role in symptom management and quality of life. Studies reveal a large subset of oncology patients with unmet needs regarding ACP and advance directive (AD) completion. Successful ACP helps to promote congruent medical treatment with patients’ values and preferences and motivates patients to complete ADs.

Objective: An evidence-based practice project was conducted to assess the effectiveness of peer-led education to nursing staff to improve ACP and AD completion among inpatient oncology and PC patients

Design: A standardized survey created from the …

Optimizing Dry Skin Management Utilizing Np Led Phone Follow-Up, Christine Vazquez Bsn, Rn, Dnp - Fnp/Agnp Student

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this project is to evaluate the impact of a healthcare provider-led standardized dry skin protocol for outpatient geriatric patients to promote overall well-being and improve quality of life.

Background: Current literature supports using the dry skin protocol to help primary care teams identify patients that require xerosis cutis skin care, particularly of the lower extremities. The primary focus of this project will be timely detection of patients with the dry skin condition that will be identified with the standardized Overall Dry Skin (ODS) scale. When the patient meets the ODS criteria, a timely discussion will be …

Implementing A Basal-Bolus Insulin Regimen Via A Manual Insulin Pump Device, Helen Stearns

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose:The purpose of this evidence-based practice project is to decrease glycated hemoglobin (HgbA1C) levelsby initiating use of a manual insulin pump in patients with Type II Diabetes Mellitus (T2DM) with poor glycemic control who are on multiple daily insulin injections (MDII).

Background: Uncontrolled hyperglycemia is associated with a myriad of complications and co-morbidities that are generally associated with vascular changes that include nephropathy, neuropathy, blindness, stroke, and heart disease (Winter et al., 2015). Coronary artery disease and cerebrovascular disease alone accounts for approximately 65% of the deaths in diabetic patients (Molinaro & Dauscher, 2017). Achieving and maintaining therapeutic …

Utilizing Telehealth Technology To Reduce Social Isolation And Depression In Seniors, Bohan Farrell

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Social isolation in the elderly has been identified as a risk factor for poor mental and physical health, as well as higher rates of mortality, depression, and cognitive decline. Loneliness is the unpleasant experience that occurs when a person’s network of social relationships is deficient in some important way, either quantitatively or qualitatively. Depression is a mental condition characterized by feelings of severe despondency and dejection, typically with feelings of inadequacy and guilt, and accompanied by lack of energy and disturbance of appetite and sleep. Physically, lonely people have more disorders, such as sleeping problems, stomach pain, and …

Bridging The Gap: Improving Hospital Discharge Through Utilization Of A Priority Care Clinic, Kristian Jamerson

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Poorly coordinated care often results in poor health outcomes. Best practices in academic literature recommend effective programs that consist of comprehensive discharge planning, complete and timely communication of information, medication reconciliation, patient and caregiver education using the teach-back method, open communication among providers, and prompt follow-up visits with an outpatient provider after discharge. Using a priority care clinic (PCC) for follow-up is one approach to decrease hospital readmissions.

Purpose: To implement an evidence-based program utilizing a PCC to facilitate post-discharge transition-in-care and reduce hospital readmissions.

Evidence-based Intervention: A PCC assists patients in their transition of care from the …

A Dnp-Led Educational In-Service To Increase Depression Screening In Primary Care, Shaylyn White

Doctor of Nursing Practice Final Manuscripts

Background: Depressive disorders are a major contributor to disability in the United States and worldwide. They are associated with multiple comorbid conditions including cardiovascular disease, obesity, stroke, and premature mortality. In the US, only 4.2% of primary care patients are being screened for depression and approximately 50% of cases of major depression are being missed.

Purpose: Implementation of a nurse practitioner-led educational intervention, discussing when, why, and how to screen utilizing the PHQ-2 and PHQ-9 screening tools, with the medical assistant staff in order to increase compliance with annual screening.

EBP Model/Frameworks: The Iowa model was used to guide implementation …

The Supplemental Impact Of Telephone-Based Lifestyle Modification Counseling In An Outpatient Weight Loss Clinic, Leslie Rangel Gonzalez Bsn, Rn, Karen Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Tony Rosales Dnp, Rn, Cns, Fnp-Bc

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of the project is to implement effective, convenient, and efficient weight loss counseling in today’s fast-paced mobile society. The project will reinforce current physical activity guidelines in correlation with the clinic’s standard dietary guidelines and pharmacological interventions. Patient adherence and motivation will be supported through lifestyle modification counseling via telephone.

Background: The prevalence of obese adults in the United States (US) increased from 33.7 percent in 2007-2008 to 39.6 percent in 2015-2016. Abnormal or excess weight gain may further impair health, as it correlates with the development of multiple preventable comorbidities such as cardiovascular disease, …

Peer-Led Education Expedites De-Prescribing Proton Pump Inhibitors For Appropriate Veterans, Mary H. Bowman

Doctor of Nursing Practice Final Manuscripts

Costly proton pump inhibitors (PPIs) have been widely prescribed since the 1990’s for prevention and treatment of ulcers and gastroesophageal reflux disease (GERD). Evidence published since 2012 demonstrates risks associated with taking PPIs longer than eight weeks. Primary care providers (PCPs) mostly de-prescribe PPIs for persons not meeting criteria for long term use. Many patients resist discontinuation.

A three-month evidenced based practice (EBP) education project was conducted by a nurse practitioner to improve PCP peer de-prescribing successes with appropriate patients in an outpatient California based veteran Primary Care Clinic. Fifteen PCPs were pretested about usual care practices between two comparable …

Nurse Practitioner-Led Obstructive Sleep Apnea Screening In Patients With An Implantable Cardiac Monitor, And Confirmed Or Suspected Atrial Fibrillation, Yarlenis Miranda, Lisa Alvarez, Mehran Moussavian, Joseph Burkard

Doctor of Nursing Practice Final Manuscripts

Background: Obstructive sleep apnea (OSA) has been linked to heart disease and vice versa. Millions of Americans suffer from this chronic sleep condition, and a great number of those affected are unaware they have it. According the American Sleep Apnea Association, 80% of patients who fall in the moderate to severe OSA category are undiagnosed. Evidence suggest that untreated OSA can lead to atrial fibrillation (AF), and other cardiovascular problems. These cardiovascular complications can increase the mortality and morbidity of patients who suffer from this sleep syndrome.

Purpose of Project: The goal of the project was to provide OSA screening …

Recommended Syphilis And Hiv Testing After Positive Sti Testing, Katherine Cayce Monaghan Rn, Bsn

Doctor of Nursing Practice Final Manuscripts

Background: Historically primary and secondary syphilis were seen primarily among men who have sex with men and rates among women remained low and rarely increased. Recent research shows that between 2013–2017, the primary and secondary syphilis rate increased 72.7% in the U.S. and 155.6% among women. Patients diagnosed with syphilis have a two to five fold increased risk of acquiring human immunodeficiency virus (HIV). Additionally, positive testing for other sexual transmitted infections (STI) might be indicators of high risk sexual behaviors and exposures that place a person at greater risk for acquiring syphilis and HIV. A southern California university student …

Barriers And Facilitators To Opioid Use Treatment And Recovery Services During Pregnancy, Loralie Woods

Dissertations

Purpose: To identify barriers and facilitators to opioid use treatment and recovery services among pregnant and nonpregnant women who misuse opioids.

Background: Over 130 Americans die daily after overdosing on opioids. Women have not been immune from opioid use disorders (OUDs), with a 4-fold increase from 1999-2010. The prevalence of opioid use among pregnant women increased from 1.5 per 1,000 hospital deliveries to 6.5. Although the annual National Surveys on Drug Use and Health (NSDUH) has provided information on risk factors for OUD related to socioeconomic and demographic factors, no studies using this data have identified barriers to opioid use …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Assessing The Need For Standardized Pre-Chemotherapy Education: An Outpatient Oncology Clinic Initiative, Spana Patel

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: In a diverse southern California outpatient oncology clinic, assess the need for standardized pre-chemotherapy education for newly diagnosed cancer patients to aid in the improvement of health literacy, self-management of side effects, satisfaction, and reduction of anxiety.

Background: Cancer patients often feel anxious, overwhelmed, and confused by the abundance of information and medical jargon that they must digest. One southern California outpatient oncology clinic identified the need for consistent, standardized procedure in providing chemotherapy education and assessing treatment knowledge in newly-diagnosed cancer patients as evidenced by: inconsistent attendance in educational classes and or appointments, inability to articulate treatment …

Screening For Iron-Deficiency Anemia In The Pediatric Population (Ages 1-17) In Gonaïves, Haiti, Cara Rose Fratianni

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this pilot project is to screen for iron-deficiency anemia in pediatric patients (ages 1-17) in a primary school in Gonaïves, Haiti. Patients with anemia will be treated with oral supplemental iron for a period of four weeks according to WHO guidelines (WHO, 2011). All students will be treated empirically for helminths per WHO guidelines, unless treated elsewhere in the last six months (WHO, 2017). Nutritional status will also be assessed using MUAC according to WHO guidelines (2017).

Background Summary: Malnutrition contributes significantly to the problem of iron-deficiency anemia, with one in four children exhibiting stunting …