Medicine and Health Sciences Commons^™

Implementing A Result Notification And Referral System In A Nurse-Led Wellness Center, Christine Bollom

Doctor of Nursing Practice

Cervical and breast cancer screenings reduce the risk of morbidity and mortality for American women. In 2017, about 70% of U.S. women over the age of 21 obtained a Papanicolaou (Pap) test, which screens for cervical cancer. African American women have a cervical cancer screening rate of 74.6% and Hispanic women have a rate of 68.6%. The cervical cancer screening rates decrease to 51% for women who are uninsured (Centers for Disease Control and Prevention, 2017). In the United States, 50% of women older than 40 are current on their screening mammogram. African American women have a screening mammogram rate …

Managing Childhood Obesity In A Primary Care Clinic, Linda Nnajiofor

Doctor of Nursing Practice

Background: Childhood obesity and overweight have increased health burdens on health care systems, and contribute to chronic diseases such as diabetes, heart disease, asthma, and cancer. Childhood obesity is very complex for healthcare providers to manage in primary care settings.

Purpose: To improve childhood overweight and obesity approach and management in a selected primary care practice (Clinic A) in a large east Texas urban community.

Objectives: 1. Increase the percentage of children and adolescents ages 2 to 19 years seen in Clinic A, who received adequate weight management and obesity counseling, to 75%. 2. Increase the number of referrals to …

Genetic Screening For Breast Cancer In The Primary Care Setting, Michael Nick Gomez

Doctor of Nursing Practice

The purpose of this project was to increase adherence to the U.S. Preventive Services Task Force and National Comprehensive Cancer Network guidelines for breast cancer screening and genetic testing.Screening for breast cancer risk factors including genetic testing helps reduce the incidence of breast cancer. A protocol was developed based on national clinical guidelines to increase screening and genetic testing for breast cancer. Provider responsibilities included screening all patients 18 years of age and older for risks factors of breast cancer, referring patients with a significant risk based on the screening for genetic testing and providing referrals for genetic counseling …

Increasing Adult Annual Wellness Visits, Martha Caceres

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase adult annual wellness visits in a high-volume family practice clinic. The significance of an adult annual wellness exam is health maintenance, disease prevention, early disease detection, and management of chronic diseases. Approximately 133 million Americans are diagnosed with at least 1 chronic disease, including cancer, diabetes, and heart disease, and 1 in 4 adults are diagnosed with multiple chronic diseases (Raghupathi & Raghupathi, 2018). In 2011, the Affordable Care Act mandated insurance companies to remove deductibles for preventative health services, relieving the financial burden of out-of-pocket expenses (Borsky et al., …

Medication Management In A Primary Care Practice, Melissa Fowler

Doctor of Nursing Practice

Improving medication management has become the 3rd National Patient Safety Goal. Medication errors cost $42 billion annually. A 5-month quality improvement project was conducted in a primary care clinic located in a south Texas metropolitan city to address medication reconciliation problems. The project improved medication management by implementing 7 tools to decrease preventable medication errors: One Source Medication List, staff knowledge pre- and post-tests, visual signs and staff badges, staff templates, Beers Criteria pocket guide, patient brochure, and a quality improvement tracking form. There were two objectives: 1. Staff would improve medication reconciliation documentation by 50%. 2. For patients 65 …

Implementing The Patient-Centered Care Paradigm In An Academic Research Environment, Fernando Orgas

Theses & Dissertations

Research Focus. The healthcare landscape is transitioning from a provider-centered care model toward greater emphasis on patient-centered care (PCC). The shift to PCC reflects efforts to increase the quality of healthcare and the care experience. The current state of research within healthcare remains focused on how to provide high-quality and sound research that will bring new equipment, procedures, and verify strategies that may benefit healthcare globally. However, changes in the healthcare atmosphere bring a new perspective to research. How is the paradigm shift to patient-centered care implemented in an academic research environment? Does this holistic mindset fully cross into …

Affordable Care Act And Preventive Care Usage: A Mixed Method Analysis Of Cardiovascular Care, Brit Peek

Theses & Dissertations

It is a commonly held belief that access to health insurance affects the level of utilization of preventive care services, and thus plays a crucial role in the effective management of avoidable chronic illnesses, decreasing levels of premature mortality, and enabling individuals to live wholesome long lives. Based on this belief, among other goals, the Affordable Care Act (ACA) was designed to increase access to health insurance and related medical services for the population of the United States. This dissertation attempts to identify whether this belief is valid or not by testing whether the usage of preventive care changed between …

Preventive Healthcare Usage In The United States: Does Health Insurance Matter, Diane Rodriguez

Theses & Dissertations

The Centers for Disease Control in the United States has maintained that adults who avoid preventive care services are more likely to suffer from long term chronic diseases because they are not addressed or treated in a timely manner. Examining the effects of providing access to healthcare to uninsured adults and increasing preventive services can help in reducing chronic diseases and enable adults to live longer, healthier lives. The purpose of this study was to identify the relationship between the utilization of preventive health services and socioeconomic factors such as insurance status, race/ethnicity, household income, marital status, education, gender, age, …

Using The Adam Questionnaire In Primary Care To Identify Hypoandrogenism In Males Aged 40 Years Or Older, Jeremy Burns

Doctor of Nursing Practice

Testosterone replacement therapy (TRT) has been shown to improve the symptoms of metabolic syndrome by reducing Hemoglobin A1C, belly fat, cholesterol, and blood pressure (Cunningham, 2015). The ultimate goal for testosterone-deficient patients is to have an improved quality of life by starting TRT. This quality improvement project was conducted at a small primary care clinic in South Texas. The project was started by screening 84 male patients ≥ 40 years of age using the Androgen Deficiency in Aging Males (ADAM) questionnaire. The ADAM questionnaire was considered positive for anyone who answered “yes” to 3 or more questions or “yes” to …

An Evidence-Based Intervention To Reduce The Use Of Physical Restraints In A Female Adolescent Population At An Inpatient Psychiatric Unit, Mambo Ndingwan

Doctor of Nursing Practice

The use of physical restraints within psychiatric units is problematic since it raises a range of legal, ethical, and clinical questions (American Psychiatric Nurses Association, 2014). The use of physical restraint has become a common practice in many psychiatric units despite the negative effects associated with its use. Selecting strategies such as verbal de-escalation to manage aggressive psychiatric inpatients shows promise with patients when used by providers and staff in mental health facilities. The purpose of this evidence-based project was to introduce and train staff to utilize the Modified Overt Aggression Scale (MOAS) and verbal de-escalation in psychiatric units in …

Program Evaluation Of An Aprn-Led Home-Based Psychiatric Care (Hbpc) Program For Vulnerable Geriatric Patients, Stacey A. Poole

Doctor of Nursing Practice

Background: Mental illness remains under-treated in older adults, especially those that are home-bound. In response to access to care gaps, an innovative advanced practice registered nurse led Home-Based Psychiatric Care program was developed as an adjunct to an established home-based counseling agency. The program involves the research supported provision of home-based psychiatric evaluations and medication management by the agency’s PMHNP. Purpose/Objectives: To evaluate the HBPC Program’s effectiveness at increasing access to timely and effective psychopharmacological treatment and management as evidenced by: (a) an increased percentage of referred patients who are being managed by the agency’s PMHNP, (b) a decrease in …

Implementation Of A Program To Identify And Assess At-Risk Patients For Peripheral Arterial Disease, Brenna Brothers

Doctor of Nursing Practice

Lower extremity peripheral arterial disease is a condition that affects approximately 200 million people worldwide and 8 million women and men in the United States (McDermott, 2015). Although there are modifiable risk factors associated with peripheral arterial disease, it is believed to be under-diagnosed and under-treated in the general population (McDermott, 2015). The progression of asymptomatic peripheral arterial disease to symptomatic peripheral arterial disease can be reduced with the introduction of medications and therapeutic lifestyle modifications (Itoga et al., 2018). The purpose of the project was to identify and assess at-risk clinic patients with typical and atypical symptoms for lower …

Surviving Sepsis: A Treatment Process Improvement In High Volume Emergency Departments, Brittney Burns

Doctor of Nursing Practice

Sepsis is the 3rd leading cause of death in the United States, accounting for approximately 270,000 deaths annually (CDC, 2017). It is the number one cause of death in hospitals, the number one cause of hospital readmissions, and the costliest diagnosis in the hospital setting (Fingar & Washington, 2015; Torio & Andrews, 2015). This quality improvement project aimed to increase the percentage of antibiotics administered within 1 hour for sepsis patients. Mortality rates significantly decrease when this goal is met (Howell & Davis, 2017). There is an 8% increase in mortality risks with every hour that passes with elevated lactic …

Implementing A Cognitive Impairment Care Planning Toolkit To Enhance Dementia Care: A Quality Improvement Project, Raquel Garcia-Priestly

Doctor of Nursing Practice

Background: Alzheimer’s is the most expensive disease in the United States with costs reaching $277 billion a year and affecting 5.7 million Americans. By 2050, 14 million Americans will have Alzheimer’s disease and related dementias (ADRD). This burdensome disease not only affects the individual, but also those who are responsible for their care, making it extremely complex to manage. Purpose: To systematically integrate the Alzheimer’s Association’s Cognitive Impairment Care Planning Toolkit in an outpatient mental health clinic to enhance care by effectively addressing the needs of patients with ADRD and of their caregivers. Objectives: Increase the number of patients with …

Improving Provider Adherence To Guidelines And Screening For Adult Depression In Primary Care, Amber Crenshaw

Doctor of Nursing Practice

The purpose of this QI project was to improve provider adherence to the Institute for Clinical Systems Improvement (ICSI) Guidelines for Adult Depression in Primary Care to enhance the screening, diagnosis, treatment, and management of adult major depressive disorder (MDD). MDD is a widespread, disabling, and treatable psychiatric disorder that is primarily treated and managed by primary care providers (PCPs). Untreated depression is prone to become chronic and can lead to pain, suffering, disability, increased morbidity and mortality, and premature death, with serious repercussions for the individual and society. Universal and routine screening in primary care for depression in adults, …

Evidence-Based Foot Care For Persons With Type 2 Diabetes, Nicole Gutierrez

Doctor of Nursing Practice

Unmanaged Type 2 diabetes leads to macrovascular changes that affect the lower extremities, thereby damaging the sensory nerve fibers and leading to diabetic peripheral neuropathy. These patients may not be able to feel pain, heat, or cold in their lower extremities and often describe feelings of numbness and tingling. This sensory deficit may lead to the development of diabetic foot ulcers which often result in amputation. These preventable foot complications may be identified promptly with adequate diabetic foot exams. Comprehensive diabetic foot examinations reduce the occurrences of foot complications associated with uncontrolled glucose management and improves health outcomes for patients …

Improving Diabetic Foot Screening In A Primary Care Clinic For Homeless Adults: A Quality Improvement Project, Theresa Causa

Doctor of Nursing Practice

The purpose of this project was to increase the adherence of clinic providers at the homeless primary care clinic by implementing the American Diabetes Association Clinical Guidelines for the evaluation and management of Type 2 diabetes with foot care. Type 2 diabetes is a chronic condition that affects 13% of the Texas adult population (Centers for Disease Control and Prevention, 2014). The homeless person's main method of transportation is walking. The complications of undiagnosed foot problems include reduced mobility, pain, lower limb amputations, and difficulty controlling chronic diseases including diabetes and depression. Provider responsibilities include screening for diabetes in all …

Implementation Of Ace Inhibitor Regimen In Patients With Type 2 Diabetes Mellitus, Rita Chukwurah

Doctor of Nursing Practice

The incidence of type 2 diabetes has increased dramatically and is associated with many problems, including chronic kidney disease. The purpose of this quality improvement project was to implement two evidence-based guidelines that may detect chronic kidney disease and slow its progression in patients with type 2 diabetes by implementing angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy according to evidence-based guidelines from the American Diabetes Association. Patients with type diabetes were screened for microalbuminuria and eGFR of < 60 mL/min/1.73 m². Based on lab results, the provider recommended either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker to patients with as …

A Quality Improvement Initiative To Improve Depression Screening In Prenatal And Postpartum Mothers, Britanni Greene

Doctor of Nursing Practice

Screening for depression during the prenatal and postpartum period is essential. The United States has the highest mortality rate in the developed world, with mental health complications being 1 of the top 5 reasons women expire within the 1st year of childbirth. The purpose of this quality improvement project was to increase depression screening during the gestational and postpartum periods in an obstetric and gynecological clinic. An administration schedule was created to administer the Edinburgh Postnatal Depression Scale (EPDS). The EPDS was administered during the initial prenatal, 32-weeks prenatal, and 6-week postpartum appointments. Women scoring 10 or higher on the …

Quality Improvement Initiative To Increase Comprehensive Eye Exams In Patients With Diabetes, Julia Khoury

Doctor of Nursing Practice

Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye …

Increasing The Incidence Of Referrals And Execution Of Diabetic Eye Examinations In A South Texas Primary Care Clinic, Marisa Macias

Doctor of Nursing Practice

Diabetes is a significant public health problem, decreasing quality of life, causing disability and death (CDC, 2017; Foos et al., 2015; Grover & Joshi, 2015). Uncontrolled diabetes can lead to several eye complications including retinopathy and blindness (ADA, 2013; Liu & Swearingen, 2017). As the number of people afflicted with diabetes rises, the need for diabetic eye examination screenings also increases to prevent disability, improve quality of life and prevent blindness (ADA, 2018; Fisher et al., 2016; Garber et al., 2015; Raman et al., 2016).

The purpose of this project was to increase the rate of diabetic eye examination referrals, …

A Quality Improvement Initiative To Facilitate Provider Adherence To Type Ii Diabetes Mellitus Guidelines, Yazmin Valencia

Doctor of Nursing Practice

Background:A significant number of individuals with type 2 diabetes mellitus do not receive comprehensive diabetes care management to maintain optimal health.

Purpose:This project was designed to facilitate provider adherence to the type 2 diabetes mellitus evidence-based practice standards of care. A primary care practice needs assessment indicated opportunities to improve care management processes which promote adherence to current clinical practice guidelines.

Methods:This 10-week quality improvement project provided the clinical staff and provider with the necessary tools to implement best practices of diabetes care. Objectives assessed throughout project implementation included the design and use of an electronic health …

Implementing A Tracking And Referral Follow-Up Process To Increase Screening Colonoscopy Adherence Within A Primary Care Setting, Stephanie Villanueva

Doctor of Nursing Practice

Within the United States, colorectal cancer is the fourth most common cancer diagnosed in both women and men. The American Cancer Society approximated that 97,220 new colon cancer cases and 43,030 rectal cancer cases would occur within 2018. Overall, it was estimated there were approximately 50,630 colorectal cancer deaths in 2018. Despite recommended guidelines, reported screening rates are only 31% to 55%, well below the goal of 75% set by the American Cancer Society. The purpose of this project was to increase preventative colorectal cancer screening referrals and completion of colonoscopies for qualified individuals age 50–75 years within a family …

Improving Residential Asthma Assessment Strategies Within A Low Socioeconomic Community, Monica Ramirez

Doctor of Nursing Practice

Background: Nationally, there are currently 6 million children under the age of 18 with asthma. There are a variety of social determinants and in-home environmental triggers that can contribute to the development of or exacerbation of asthma in children. Therefore, it is important to recognize and improve the needs of children with asthma in older homes and in households with a lower socioeconomic status.

Aim: The aim of this project was to decrease the number of in-home environmental asthma triggers within at-risk homes in San Antonio, Texas.

Purpose: The purpose of this evidence-based practice project was to improve asthma outcomes …

Ozone Induced Effects On The Mammalian Visual System, Jordan Wetz

Theses & Dissertations

Research Focus. Millions of people who suffer from retinal disease live in air-polluted environments. The impact of the gaseous air pollutant ozone (O₃), a strong oxidant, on the retina is unknown. The aim of the present study is to compare the electroretinographic responses between control (no O₃ exposure) and O₃ -exposed rats and to better understand the effects of O₃ on retinal function.

Materials and Methods. Age-matched adult female rats were separated into two groups (N = 6), 3 control and 3 experimental. The experimental group was exposed to 0.4 ppm O₃ for …

Screening Of Crude Microalgal Extracts For Antimicrobial Activity, Patrick Matulich

Theses & Dissertations

Microbial biofilm associated infections are a significant threat to patients with medical devices and are partially responsible for the increased resistance seen in nosocomial infections. The biofilm chemical and physical properties restrict access of chemotherapeutic agents. Therefore, there is a need to enhance the antimicrobial effects of current chemotherapeutic agents. Microalgae live in competitive environments that include film-forming, opportunistic pathogens S. maltophilia and C. albicans. Extracts from 5 diverse species of microalgae were screened for antimicrobial enhancing effects against established biofilms with two different extraction solvents, 3:1 hexanes and isopropyl (HIPA) and 2-methyltetrahydrofuran (2-MTHF).

Three species, B. braunii, …

Nursing Leaders’ Ethical Decision-Making About Professional Boundaries And Nurse-Patient Relationships: A Mixed Methods Explanatory Sequential Design, Pamela Scott

Theses & Dissertations

The purpose of this mixed methods explanatory sequential design study was to ascertain nursing leaders’ knowledge and skill in ethical decision-making when evaluating and managing professional nurse-patient relationship boundaries. It was also the purpose of this study to better understand nursing leaders’ perception of moral, cognitive, and organizational factors influencing their ethical decision-making in evaluating and managing professional nurse-patient relationships, with the intent of generating a theory grounded in the views of the participants as a final outcome of the study. The two theories, virtue ethics and self-efficacy comprise the ethicality construct of the conceptual framework explaining the nurse leaders’ …