Medicine and Health Sciences Commons^™

Visual Aid For Hemoglobin A1c Results In Primary Care: A Pilot Study, Sean A. Fiore

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Low numeracy and health literacy are common problems that negatively influence healthy decision-making. Laboratory test results are often given to patients without consideration of health numeracy or literacy. This project aims to pilot a visual aid for common test results and gauge patient understanding and motivation for health improvement.

Methods: This is an exploratory pilot study involving the implementation of an evidence-based visual aid for hemoglobin A1c laboratory test results in a primary care clinic. The author developed an electronic tool to pictographically display an individual’s risk based on their A1c value and history of diabetes. Results …

Impact Of An Ehr-Based Tool On Copd Management In Primary Care, Nancy Ann C. Kelly Rn

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: GOLD (2017) guidelines provide evidence based recommendations for treating COPD, although their employment in clinical practice is inconsistent. Lack of a standardized method to view COPD specific information within the EHR during patient encounters complicates visits and development of GOLD-guided treatment plans. Our goal is to determine the impact of an EHR-based tool on relevant COPD disease measurements (spirometry rates, pneumococcal vaccination rates and COPD Action plans)

Methods: An EHR-based tool (SmartPhrase) was developed and released to providers to facilitate GOLD(2017) guideline reference during patient encounters. Computer based instructional videos of GOLD (2017) guidelines and EHR-based tool …

Improving Adolescent Health Care Transition: Piloting The Transition Readiness Assessment Questionnaire, Meghan D. Foster Msn, Rn-Bc

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Successful adolescent health care transition (HCT) is a vital process in providing developmentally appropriate care and minimizing negative outcomes, especially in adolescents with special health care needs. The purpose of this mixed-methods quality improvement project was to pilot the Transition Readiness Assessment Questionnaire (TRAQ) tool in a pediatric rheumatology clinic and assess its utility as a transition tool as well as to inquire about specific patient and family-based transition needs.

Methods. The TRAQ tool and follow-up survey were administered in dyads to all established pediatric rheumatology patients between the ages of 12-18, and one caregiver, who presented to the …

Improving Inpatient Pediatric End Of Life Care Education For Bedside Nurses, Grace Wolcott

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose:45,000 infants, children and adolescents die in the US annually. Bedside nurses in inpatient pediatric units receive minimal education on the topic of pediatric end of life care. The purpose of this project was to assess the needs of pediatric inpatient nurses and trial an online educational module for effectiveness in teaching nurses about pediatric end of life care

Methods. This was a quality improvement project aimed at inpatient nurses on 4 different units. Electronic 7 question pre-surveys were sent via email, followed by an educational module accompanied by a 3 question post-survey.

Results. Of 78 participants, 51% reported …

Screening For And Intervening In Food Insecurity In Vermont Pediatric Primary Care, Gussie Belisle

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Food insecurity places patients at risk for adverse health outcomes, and in VT, one in six children are food insecure. Despite this finding, the validated 2-item food insecurity screening tool is not routinely being utilized in pediatric primary care settings. The purpose of this project was to increase rates of food insecurity screening and subsequent connection to appropriate resources in a pediatric practice in VT.

Methods: In this quality improvement project, the 2-item food insecurity screening tool was implemented in the health maintenance visits of patients age 1-21 at three pediatric primary care offices. Positive screenings were referred for …

Exploring Evidence-Based Mental Health Prevention Programs To Build Resiliency In College Students, Elizabeth Anderson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Mental health diagnoses and utilization of services are increasing amongst college students. Mental health prevention programs can cultivate resiliency traits that are protective of mental health. The purpose of this project is to assess for the need of a mental health prevention program at a small urban-college in Vermont and make program recommendations based on staff and student needs.

Methods: A needs assessment project was conducted at the college student health center. Separate needs surveys were created and distributed to students and student wellness staff. Student resiliency was assessed using the Brief Resiliency Scale, a validated tool. Literature review …

Incorporating Routine Social Media Screening In Pediatric Primary Care, Emily Scribner

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Excess or unsafe media use by adolescents can have numerous implications on health and behavior. Pediatric primary care providers (PCPs) play an important role in helping adolescents navigate the digital age, but discussions regarding media use occur inconsistently. This project aimed to develop a routine media screening tool and promote consistent media conversations during every well child visit for adolescents age eleven and older at a pediatric practice.

Methods. This evidence-based QI project utilized a pre- and post-test design with a 30-minute educational in-service provided to PCPs. Data collection lasted for three months. All patients age eleven and older …

Improving Contraception Among Female Syringe Exchange Clients: A Reproductive Needs Assessment, Gena Zollman

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Women with opioid and other substance use disorders have a high rate of unintended pregnancy and a low rate of effective contraceptive use. Integrating family planning (FP) services into medication-assisted treatment (MAT) clinics has increased rates of initiation and adherence to contraception among this population. This study assesses the reproductive health needs of female clients in a syringe exchange program (SEP)to assess if integrating FP services would improve access to contraception.

Methods: Female clients of a SEP voluntarily completed an anonymous survey to determine demographics, FP needs, and barriers to accessing care, and were compensated with $20 gift cards. …

Improving Health Literacy Among Latino Migrant Dairy Farmworkers, Dayna A. Stimson

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background/Purpose: Latino migrant farmworkers are a marginalized and medically underserved population in Vermont and nationally. They experience significant health disparities and barriers to healthcare access compared to others living in rural areas. Barriers include limited knowledge regarding available services and low general and health literacy. These barriers lead to poorer health outcomes. The purpose of this evidence-based project was to enhance health literacy and follow-up care for migrant farmworkers by improving health literacy in a community health outreach setting.

Methods: In northwestern Vermont, 33 outpatient migrant farmworkers were recruited following health screening visit and referred for follow-up. AHRQ …

Development And Implementation Of Comprehensive Sexuality Education Programs For Middle School Students, Minta Trivette

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background: Sexual activity in adolescents carries population health risks such as pregnancy and sexually transmitted infection. Comprehensive sexual health education programs can be an effective strategy to help young people delay initiation of sexual intercourse, reduce the number of sexual partners, and increase condom and contraception use. As of the 2018/2019 school year, Burlington School District (BSD) middle schools did not have a comprehensive sexual health and safe relationship education program.

Purpose: Development and dissemination of comprehensive sexual health and safe relationship curricula for Burlington School District (BSD) middle schools.

Methods: This educational intervention was aimed at middle school health …

Mitigating Negative Impacts Of Adverse Childhood Experiences: A Strength-Based Approach, Nicholas Montello Iii

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Mitigating Negative Impacts of Adverse Childhood Experiences:

A Strength-Based Approach

Nicholas Montello, RN

Purpose: Adverse Childhood Experiences (ACEs) are common among Vermont youth, and Vermont has insufficient treatment resources to address their negative impacts. A strength-based approach (SBA) mitigates the negative impacts of ACEs by using a person’s assets to build resilience to ACEs. This project is designed to increase healthcare worker and patient/caregiver knowledge of ACEs via the SBA.

Methods: An evidence-based quality improvement intervention was implemented at a pediatric primary care office in rural Vermont, based on the Bodega Model for a strength-based approach. Healthcare worker knowledge and …

Implementation And Evaluation Of A Nurse-Administered Dysphagia Screening Tool To Identify Patient’S At High Risk For Post-Extubation Dysphagia, Andrew D. Kehl

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Post-extubation dysphagia (PED) occurs in 3% to 62% of intensive care unit patients. Patients with moderate or severe PED are more likely to experience pneumonia, reintubation, or death. Early identification of post-extubation dysphagia is crucial so diet modifications, temporary feeding measures, and/or advanced swallow evaluations and therapies can be implemented. The purpose of this quality improvement project was to implement a nurse-administered dysphagia screening tool (NADST) for post-extubated patients in a 21-bed mixed medical intensive care unit (MICU) at a large academic medical center.

Methods: Utilizing quality improvement methods, a modified dysphagia screening tool was trialed in …

Developing An Evidence-Based Mentorship Program For New Graduate Nurse Practitioners, Matthew R. Guy

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Excessive job turnover in the novice nurse practitioner (NP) population is a stressful phenomenon for providers, adversely affecting institutional financial performance, and has the potential to lead to poorer health outcomes for the individuals we serve. The purpose of this investigation was to assess the need for the establishment of a structured mentorship program for new graduate nurse practitioners. As an aspect of an institutional quality improvement project, the overall goal is to reduce new graduate NP employment turnover.

Methods. A literature search was conducted in order to appraise and synthesize available knowledge regarding employment turnover and mentorship programs …

Provider And Staff Education To Improve Health Care For The Lgbtq+ Population, David Segel

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Abstract:

Purpose: The LGBTQ+ population makes up ~10% of the total population of the world. In the U.S., Vermont has the highest per capita LGBTQ+ population out of any other state. This population is at high risk for numerous health disparities and discrimination by providers. The disparities include higher rates of STI’s, substance use, mental health diagnoses, domestic violence, sexual and physical assault, and lower rates of routine cancer screenings. These can be mitigated by accepting and knowledgeable providers.

Methods: This project sought to improve health care for LGBTQ+ individuals in Vermont by offering an in-person seminar educating providers and …

Implementation Of A Chronic Pain Functional Assessment Tool In Primary Care Practice, Jude Emerson Stevens

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Background

An estimated 20% of patients with non-cancer pain symptoms or pain-related diagnoses receive an opioid prescription. Current guidelines advocate use of a functional assessment as a strategy to improve the efficacy and safety of chronic pain management using opioids. This project aimed to integrate functional assessments into patient care visits for chronic pain and optimize safe and effective prescribing.

Methods

This quality improvement project was conducted at a primary care clinic in Burlington, VT. Baseline data on current functional assessment utilization and barriers amongst providers were collected. The validated Pain, Enjoyment, and General Activity (PEG) scale was administered from …

Assessing Need And Resources For Providing On-Site Access To Long Acting Reversible Contraceptives In University Student Health Setting, Madeline Howe

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Over 50% of all pregnancies in the state of Vermont are unintended, despite the availability of effective contraceptive methods. Long-acting reversible contraceptives (LARCs), including intrauterine contraceptive devices and implantable contraceptive devices, are the most effective form of reversible contraception. However, they make up a minority of contraceptive use. Studies have established that women overwhelmingly choose LARCs when educated about their efficacy, cost, and convenience.

Methods. A needs assessment was conducted using data query of electronic health records and informal interviews with Student Health Services (SHS) providers and administrators at a northern New England university. Suppliers and insurers were contacted …

Improving Screening For Depression And Fall Risk In Community Dwelling Older Adults, Devan C. Lucier

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose. Falls and depressive symptoms are common in the older adult population and are associated with significant morbidity and mortality. The relationship between depression and falls is bidirectional. Given that community health nurses are critical health care personnel in assessing risk for depression and falls in the older adult population, the purpose of this project was to implement screening measures for depression and falls in an older adult population.

Methods:Nurses from a community health outreach team implemented depression and fall risk screening assessment with an older adult population 65 years and older in their homes. The Geriatric Depression Scale, …