Medicine and Health Sciences Commons^™

Dental Caries Screening For Food Insecure Children, John Joseph Kane

Doctor of Nursing Practice

Background. Dental caries is the most common childhood disease, disproportionally impacting minorities, and socio-economically disadvantaged children. Food insecurity impacts 23.6% of children in Texas; the majority being African American and Hispanic. Food insecurity screening rates are abysmal. Dental caries and food insecurity are significantly correlated and likely syndemic. Purpose. Implement oral examination and the “Hunger Vital Sign” screening tool in detecting dental caries and food insecurity at an urban pediatric urgent care center. Evidence. Food insecure children experience adverse health outcomes, impaired long-term health outcomes, developmental and cognitive delays, psychosocial delays, and oral health deficiencies including caries and malabsorption of …

A Quality Improvement Project To Improve The Management Of Group A Streptococcalpharyngitis Among Children, Tara Denise Gutierrez

Doctor of Nursing Practice

Group A Streptococcal (GAS) pharyngitis is one of the most common pediatric illnesses and accounts for more than ten million yearly medical visits. GAS is commonly misdiagnosed due to overlapping symptoms. The health care provider needs to distinguish which criteria warrant testing for GAS and the recommendations for management and treatment.

The purpose and objectives of this quality improvement project were to improve adherence to the 2021 Canadian guidelines for the management and treatment of GAS pharyngitis in a small community urgent care clinic. Anticipated outcomes for this project included a decrease in unnecessary testing for GAS pharyngitis, a decrease …

Program Development And Expansion Of A Clinician-Driven Wound Care Program At An Outpatient Wound Care Center, Zhenhai Niu

Doctor of Nursing Practice

Problem. Patients with chronic wounds often present with additional physical and emotional problems because healing of chronic wounds may require months to resolve. Practitioners develop treatment plans based on their own training and clinical expertise, but unfortunately, there are no universal guidelines to inform the management of chronic wounds. Expanding multi-factorial assessments and interventions could improve patient outcomes. The purpose of this project was to implement a wound care protocol for outpatient wound care clients based on a nutritional and psychological self-assessment. Methods. A patient-completed checklist, done on arrival to the clinic, triggered clinician-driven protocol interventions addressing mental health and …

Implementation Of The Mood Disorder Questionnaire In A Psychiatric Inpatient Facility, Sandy Ann Harris

Doctor of Nursing Practice

Background. Bipolar disorder is a combination of multiple mood disorders associated with high suicide rates. The mood disorder questionnaire is a reliable, cost-effective, and time-effective screening tool to aid in diagnosing bipolar disorder (Carvalho et al., 2015; Miller & Black, 2020). Purpose. To implement the mood disorder questionnaire during admission to improve the accuracy of diagnosing bipolar disorder among providers in patients without a history of bipolar disorder. Goal. To increase the utilization of the mood disorder questionnaire thereby increasing bipolar disorder diagnosis accuracy. Objectives. 100% of the team will attend an in-service on the project; 60% of patients without …

Improving Post-Discharge Engagement Of Mental Health Patients In The Veterans Affairs South Texas Healthcare System, Nneoma Lewis

Doctor of Nursing Practice

Discharge from a hospital is a high-risk period for mental health patients, as 20% experience an adverse event within 30 days of discharge. Poor discharge engagement can lead to complications for recovery, which include an increased risk for readmissions, longer length of stay, increased risk for suicide, and death. Hospital stays cost the United States $377.5 billion dollars per year; there is pressure for hospitals, health plans, and providers to examine the admission and discharge processes to improve healthcare delivery, transition of care, and patient health outcomes. At a South Texas VA, 67.66% of mental health patients attended all their …

Utilizing A Validated Screening Tool And Treatment Protocol For Managing Agitation And Violence In A Psychiatric Emergency Services Unit, Zarah Ashcroft

Doctor of Nursing Practice

Background and Significance. Agitation is a significant concern in psychiatric units. If not detected early, agitated individuals are at high risk for becoming aggressive and violent, potentially causing harm to themselves, hospital staff, and property. The Psychiatric Emergency Services unit receives agitated and violent patients with psychiatric illnesses and substance use disorders. Purpose/Goal/Objectives. This quality improvement project aimed to implement a treatment protocol using the Broset Violence Checklist (BVC) to promote the early identification and management of potential for patient violence and aggression. Methods/Key Activities. Staff education for the nurses and providers on assessing patients at risk for aggression and …

Setting Goals For Patients With Type 2 Diabetes In Primary Care, Courtney Renee Padilla

Doctor of Nursing Practice

Background. Type 2 diabetes is prevalent amongst the Hispanic population and increases the risk of developing chronic serious health issues (CDC, 2022, April 4). Setting attainable and realistic goals for patients with type 2 diabetes is foundational in achieving glycemic control and improving quality of life (ElSayed et al., 2023a). Purpose. To increase goal setting in patients with type 2 diabetes in the primary care setting. Goal. To promote self-management in patients with type 2 diabetes. Objectives. 100% of staff and providers will attend an in-service on goal setting using a self-management goal tool; 75% of patients will choose to …

Central Activation Of Orl-1 Receptors In Heart Failure Models, Jeffrey Angell

Theses & Dissertations

Heart failure is a prevalent and debilitating disease associated with high morbidity and mortality rates worldwide and is the leading cause of death in the United States. While various therapeutic strategies have been developed and approved to manage heart failure, exploration of novel targets and mechanisms are essential for improving patient outcomes. This thesis investigates the therapeutic potential of the central activation of opioid receptor-like 1 (ORL-1) by nociceptin in a rodent heart failure model.

Furthermore, this study aims to elucidate the central mechanisms underlying nociceptin induced cardiovascular and renal effects in heart failure. This involves investigating neuronal pathways and …

Anxiety Screening At A Psychiatric Inpatient Facility: A Quality Improvement Project, Irene Akwitti

Doctor of Nursing Practice

Background. Generalized anxiety disorder is characterized by persistent anxiety and uncontrollable worry occurring more days than not for a minimum of 6 months (Patriquin & Mathew, 2017). Presently, anxiety screening and evidence-based practice treatment for adults are suboptimal. It is impossible to overemphasize the importance of early diagnosis and prompt treatment of generalized anxiety disorder in patients. Purpose. The purpose of this quality improvement project was to implement the Generalized Anxiety Disorder-7 (GAD-7) screening tool, a validated, evidence-based instrument, in a psychiatric inpatient facility to improve early detection and treatment of anxiety disorders in patients. Methods. Staff members were educated …

Preserving The Force: A Quality Improvement Project To Reduce The Risk Of Opioid Use Disorder In The Military, Lecreshia S. Shields

Doctor of Nursing Practice

Military service members incur combat and noncombat related injuries which may lead to acute or chronic pain. Treatment of these conditions with opioids may place them at risk for opioid use disorder (OUD). Opioid related overdoses among the military community increased by 50% from 2010 to 2019. The Sole Provider Program (SPP) is recommended to address the risks of OUD among Veterans receiving care at military installations. The goal of this evidence-based project was to ensure that all persons who receive opioid prescriptions at a military facility were evaluated for inclusion into a SPP and prescribed naloxone. Objectives included: 1) …

A Quality Improvement Project To Screen For Food Insecurity In Adults With Anxiety Or Depression, Kelsie Evelyn Kroll

Doctor of Nursing Practice

Background Food insecurity is the limited availability and inconsistent accessibility of healthy foods (Coleman-Jensen et al., 2022a). Food insecurity contributes to mental health problems. Individuals with food insecurity have greater odds of screening positive for depression and anxiety (Wolfson et al., 2021). The Hunger Vital Sign™ screening tool is a 2-questions evidence-based tool used to identify food insecurity (Hager et al., 2010). Purpose. Implement the Hunger Vital Sign™ tool at a non-profit behavior health clinic to identify food insecurity in adults who screened positive for anxiety or depression, offer resources for them to obtain nutritious food, and provide additional information …

The Importance Of Contrast Sensitivity, Color Vision, And Electrophysiological Testing In Clinical And Occupational Settings, Frances Silva

Theses & Dissertations

Visual acuity (VA) is universally accepted as the gold standard metric for ocular vision and function. Contrast sensitivity (CS), color vision, and electrophysiological testing for clinical and occupational settings are warranted despite being deemed ancillary and minimally utilized by clinicians. These assessments provide essential information to subjectively and objectively quantify and obtain optimal functional vision. They are useful for baseline data and monitoring hereditary and progressive ocular conditions and cognitive function. The studies in this dissertation highlight the value of contrast sensitivity, color vision, and cone specific electrophysiological testing, as well as the novel metrics obtained with potential practical clinical …

The Efficacy Of Analgesic Subdissociative Dose Ketamine In Trauma Casualties Treated By U.S. Military Special Operations Medical Professionals In A Prehospital Environment, Darin Schwartz

Theses & Dissertations

Research Focus. This study’s main objective was to determine the efficacy of sub-dissociative ketamine to reduce the pain of trauma casualties treated by U.S. military medical professionals in a prehospital environment evidenced by the 0–10 numeric rating scale (NRS) for pain. Research Methods. This quantitative study was accomplished using a pragmatic approach integrating social cognitive theory complemented by mixing methods using qualitative phenomenological influence through narrative inquiry. This exploratory retrospective, cross-sectional study, utilizing a quasi-experimental pretest-posttest design, used deidentified sample data (N = 47) for secondary analysis from U.S. Special Operations medical providers and were included in a casualty …

Medicare Shared Savings Performance: Three-Year Pandemic Analysis, Bryan Adams

Theses & Dissertations

The Centers for Medicare and Medicaid's (CMS) Office of Actuary predicts that U.S. national health expenditures will surpass U.S. gross domestic product per capita by 1.1% annually until 2028, totaling $6.2 trillion in healthcare spending. A significant portion of this spending, 36%, is attributed to Medicare and Medicaid. To address this issue, CMS has implemented the Medicare Shared Savings Program (MSSP) to assist Accountable Care Organizations (ACOs) in reducing healthcare costs and improving the quality of care for beneficiaries. The main objectives of this dissertation are twofold. Firstly, it aims to investigate the relationship between various factors, such as quality …

How To Collaborate And Not Just Coexist: An Explanatory Sequential Mixed Methods Study On The Impact Of A Physician And Nurse Interprofessional Education Program On The Development Of Early Career Pediatrician Communication Skills And Collaborative Behaviors Once In Practice, Elizabeth L. Wueste

Theses & Dissertations

Healthcare organizations are challenged to build and develop interprofessional (IP) teams capable of delivering effective patient care (Tang et al., 2018). Historically, these multiple professional roles are not formally educated together but are all expected to work in unison once they enter practice (El-Hanafy, 2018). This lack of relational foundation has led to age-old conflict between the physician and nurse roles on the care team (Stein et al., 1990). This conflict has been attributed to a lack of role definition or an overemphasis on hierarchical structures, poor communication, and the inability of physicians to collaboratively work with their nurse counterparts …

An Interprofessional Prediabetes And Diabetes Self--Management Education Quality Improvement Project Among Vulnerable Populations At A Tuberculosis Hospital, Robert Saul Castro Natal

Doctor of Nursing Practice

Background. Patients greatly benefit from diabetes self-management education (DSME) as it boosts knowledge and self-efficacy, decreases body weight, fasting blood sugar, and hemoglobin A₁C levels, and improves overall health outcomes in a cost-effective manner. Unfortunately, many individuals with prediabetes and diabetes who qualify for DSMEs do not attend these classes nor receive sufficient prediabetes and diabetes support elsewhere to attain guideline recommended metrics. However, individuals from vulnerable populations and without DSME education experience disproportionate diabetes-related complications worsening health outcomes. Aims: Increase general prediabetes and diabetes knowledge, facilitate behavior change, improve glycemic, metabolic, and lipid values, and increase …

Implementing Food Insecurity Screening On A College Campus, Norma Martinez

Doctor of Nursing Practice

Background. Students attending universities have higher rates of food insecurity than U.S. households. Most college campuses do not routinely screen students for food insecurity, which can affect students’ health and school performance. Currently, the university health clinic does not screen students for food insecurity. Purpose. To screen all students who present to the university clinic for food insecurity and evaluate students with food insecurity for malnutrition. Evidence. Foreman et al. (2018) and Abu and Oldewage-Theron (2019) found that food insecurity was present at some of the largest Texas universities at rates higher than the national average. Project Objectives. To screen …

Reducing Physical Restraints And Emergency Psychiatric Medications On An Inpatient Psychiatric Unit With The Broset Violence Checklist, Victoria Hernandez

Doctor of Nursing Practice

Background: Physical restraint and psychiatric emergency medication use, especially psychotropic medications, is problematic, negatively impacting patient safety on psychiatric units (Ambwani et al., 2021; Iuppa et al., 2013; Rahman, 2021). The Bröset Violence Checklist (Woods & Almvik, 2002), a short-term violence-predicting tool, has been used in the inpatient setting to predict violent outbursts and determine when high-level violence interventions are needed.

Purpose: The purpose of this project was to recognize signs and symptoms of aggression and agitation early and intervene to reduce the use of physical restraints and emergency restraint medications on an inpatient psychiatric unit, thereby improving patient safety. …

Addressing Obstacles In Following Prescribed Medication Regimens In Patients With Type 2 Diabetes Mellitus, Cristina Sarro

Doctor of Nursing Practice

Background. Type 2 diabetes is the ninth leading cause of death in the United States. Micro/macro vascular complications are common in diabetes. Purpose. To implement an evidence-based protocol addressing obstacles for patients with type 2 diabetes in following their prescribed medication regimens to reduce glycosylated hemoglobin levels. Evidence. Failure to follow treatment plans increases diabetes complications. Perceptions and complexities of treatment plans, side effects of therapies, and cost contribute to patients not taking their medications as prescribed. Goals. To increase the number of patients with type 2 diabetes who follow their prescribed medication regimen and reach their targeted glycosylated hemoglobin. …

Optimizing Diabetes Self-Management Using Continuous Glucose Monitoring And Improving The Transition Of Care For Adult Patients Discharged From The Hospital, Nikki Rose Angeles

Doctor of Nursing Practice

Background: Diabetes mellitus is a chronic medical condition that affects more than 34 million Americans (Centers for Disease Control and Prevention, 2020). The financial impact of diabetes is significant. Americans spend $327 billion on direct medical costs to treat the disease and its associated complications (American Diabetes Association, 2018). The management of diabetes requires a multidisciplinary approach that involves healthcare providers, diabetes self-management support resources, and a high level of commitment from the patient. Patients with diabetes discharged from the hospital often receive fragmented and inconsistent information about managing their health issues. As they transition from hospital to home, their …

Nursing Students' Knowledge Of And Attitudes Towards Near-Death Experiences, Laura Lee Varela

Theses & Dissertations

Incidence of reported near-death experiences (NDEs) has increased over decades; however, they continue to be inappropriately pathologized or dismissed. These types of responses to disclosures of NDEs by patients can potentially lead to them having problems integrating the experience into their lives. The purpose of this study was to assess undergraduate nursing students’ levels of accurate knowledge of and attitudes towards NDEs and to determine the predictors of nursing students’ knowledge of and attitudes toward NDEs. Additionally, I explored the sources in which nursing students acquire NDE knowledge. I accomplished this by using a cross-sectional, correlational research study design. I …

U.S. Army Physician Assistant Retention: A Latent Class Analysis, Robert Greener

Theses & Dissertations

Introduction: Retaining employees is crucial to the success of organizations. While significant effort has been made to model employee retention, models have been unable to significantly predict retention. The purpose of this quantitative, non-experimental, cross-sectional study was to develop an improved employee retention model which could be used as a practical guide to improve employee retention. Materials and Methods: The study analyzed a survey created, implemented, and collected by the Statistical Cell at the U.S. Army Center of Excellence. In September of 2020, all 864 active-duty PAs were sent a link to the survey and 290 completed the survey, …

Implementing Evidence-Based Adult Psychiatric Inpatient Depression Assessment, Treatment, And Post-Hospitalization Referral, Lucy Flores

Doctor of Nursing Practice

Purpose: This project was designed to strengthen the quality of depression assessment with evidence-based depression assessment tools in inpatient psychiatric units.

Background: Missed diagnosis and treatment of depressive disorders contribute to the most severe outcome of depression: suicide. A crisis stabilization facility with inpatient psychiatric units had significant opportunities to improve clinical outcomes by screening for depression in adults and to monitor symptoms with evidence-based tools.

Methods: The 12-week quality improvement project included implementation of staff education sessions of evidence-based tools to screen, monitor, interpret scores, and detect risk modifiers. The design and build with Information …

Patient Care Management Of Hypertension Through Improving Follow-Up And Reducing Missed Appointments In A Primary Care Clinic: A Qi Project, Victoria Idubor

Doctor of Nursing Practice

Background. Missed follow-up appointments constitute significant problems clinics and health centers face nationwide. A significant portion of primary care providers’ patients will require follow-up appointments to manage their chronic illnesses. About 20 to 40% of patients seen at this clinic have a history of hypertension. Uncontrolled hypertension has been shown to increase the risk of certain cardiovascular disease events and mortality. Follow-up appointments are crucial for patients with hypertension to monitor for more life-threatening signs and manage their overall care. Purpose. The purpose of this project is to improve the timely management of care for patients with hypertension …

Implementing The Depression Screening Tool Phq-9 In The Annual Wellness Exam Of Concierge Family Medicine, Eric Iglesias

Doctor of Nursing Practice

Abstract

Background: Depression has been one of the most common mental health disorders that our population fact but is underdiagnosed and undertreated. Primary care providers are often the first line of defense in detecting depression. Because of this, implementing a depression screening tool in a primary care setting will improve holistic management of care and improve quality of life.

Project Aim: The aim of this project was to increase the number of clients who are evaluated for depression by using the PHQ-9 screening tool during their annual wellness exam and initiate treatment according to the Veteran’s Affairs/Department of Defense Depression …

Quality Improvement Project: Communication Guidance During And Following Maternal Hemorrhage, Kathleen Giramur

Doctor of Nursing Practice

Background. Maternal hemorrhage is a significant cause of worsening maternal morbidity and mortality in the United States. If timely, effective, and compassionate communication is not provided during and following traumatic birth events, negative mental health problems may result that affect maternal well-being, bonding with the baby, and family relationships. A gap analysis carried out at the clinical site showed that a written, evidence-based guidance on communication with patients and families during and after a maternal hemorrhage event was needed. Compliance through documentation is required by the Joint Commission. Trauma-Informed Care is an evidence-based communication approach that incorporates principles of safety, …

Strategies To Prevent Hospital Acquired Pressure Injuries In The Intensive Care Unit, Theresa Ann Pomerleau

Doctor of Nursing Practice

Background. Despite prevention strategies, hospital acquired pressure injuries continue to occur, especially in intensive care units. This led to an impetus for nurses to have a robust knowledge of pressure injuries to promulgate prevention strategies in their practice. Significance of the Problem. The hospital acquired pressure injury rate in the medical surgical intensive care unit for the year 2019 at Hospital X was greater than the national benchmark. Purpose. The global aim statement was to improve the quality of patient care by developing an evidence based educational suite in collaboration with interdisciplinary team members for prevention of hospital acquired pressure …

Implementation Of Comprehensive Footcare Program Within Primary Care, Moses Ademola-Ojo

Doctor of Nursing Practice

The incidence of diabetes and its complications is escalating, with over 34.2 million adults in the US having diabetes (CDC, 2020). Despite a decade-long decline in lower-extremity amputations, the incidence is growing (Nichols, 2019), with little emphasis on preventive foot evaluations within primary care. The purpose of this project was the implementation of a multi-faceted program aimed at early identification of lower extremity complications with focused patient education, improved assessment, and documentation, and referral for specialty care. The intervention process included staff training, patient education, foot examination, monofilament testing, pinprick tests, ankle reflex, and tuning fork test. Foot abnormality, loss …

Providing Resources To Caregivers Of Pediatric Mentally Ill Clients And Assessing For Caregiver Burden, Stacy Dee

Doctor of Nursing Practice

Background. Provision of educational and supportive resources to the caregivers of children with mental illness can help create an environment of advocacy and understanding between the child, caregiver, and provider. In depth and comprehensive learning about their child’s mental illness cannot be accomplished in a one-hour new patient appointment or established patient appointment of 20 minutes. Purpose. The purpose of this practice improvement project was to facilitate educational and community support for caregivers of pediatric clients with mental illness and evaluate if caregivers require additional support due to burden. Objectives. (a) 100% of caregivers of pediatric clients who have appointments …

Depression Screening Upon Admission At An Addiction Facility: A Quality Improvement Project, Eric Aniekwena

Doctor of Nursing Practice

More than one in six Americans will have a diagnosis of a substance use disorder at some time in their life. According to the National Institute on Drug Abuse (2020), those with a substance use disorder will have an increased rate of having a comorbidity of depression or depression symptoms during treatment, leading to poorer outcomes. The purpose of this quality improvement project was to increase provider and staff adherence to the treatment standards outlined in the Veteran’s Affair/Department of Defense Clinical Practice Guideline for the Management of Major Depressive Disorder (Veteran’s Affairs/Department of Defense, 2016). During this 10-week process, …