Nursing Commons^™

Implementation Of A Nurse-Led Diabetes Self-Management Education (Dsme) Program In Primary Care, Jamie Lee

Nursing and Health Professions Faculty Research and Publications

Type 2 Diabetes Mellitus (T2DM) is a serious concern, that requires close monitoring and facilitation of self-management skills and strategies, as well as development of a sense of self-efficacy, in patients with this chronic disease. The development of nurse-led Diabetes self-management education (DSME) programs, combined with a multidisciplinary approach to care and management, is a safe and effective means of helping patients with uncontrolled T2DM to cultivate positive health behaviors, prevent long-term disability and effectively control blood sugars.

A DSME program like this was developed and implemented at Mercy Midtown Family Practice, for patients with a glycosylated hemoglobin (HbA1c) of …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

Increasing Hcahps Scores By Scripting Of Hourly Rounding, Katherine Rivera

Doctoral Dissertations and Projects

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness …

Knowledge And Attitude Of Nurses In A New Rn Graduate Residency Program Regarding Pain Management, Kathryn Lee Wampole

Doctoral Dissertations and Projects

Most people have encountered pain at some point in their lives. It is a very common complaint nurses hear from patients. When assessing patients, nurses are taught to take what the patient says as his or her pain level as fact. Pain is not a vital sign that can be measured with medical equipment like temperature or blood pressure. Therefore, many nurses find assessing pain challenging. Adding to the complexity of pain management is the current opioid crisis. To help combat some of these issues, the project leader worked with healthcare administrators at a regional teaching hospital in the southeastern …

Pediatric Primary Care Concussion Evaluation And Management, Kaitlyn Layman

Doctoral Dissertations and Scholarly Projects

Concussions are an important and timely subject, especially within the pediatric population, as they are the most involved in extracurricular contact sports and are susceptible to concussions and their sequelae. The researcher performed a quasi-experimental pilot study in a pediatric primary care office where the researcher educated 15 providers on the HEADS UP concussion screening tool and management approach. The researcher gave providers pre- and post-intervention surveys to determine if providers’ comfort and knowledge regarding assessing and managing concussions within the pediatric primary care setting changed. Four providers participated in the study. The researcher conducted a chart review two months …

Implementation Of A Screening Protocol To Improve Provider Assessment Of Depression In Patients With Psoriasis, Marlee Bryant

Doctoral Dissertations and Scholarly Projects

Patients with psoriasis are at an increased risk for depression. Despite this risk, many dermatology care providers do not screen for depression in practice, including providers at the target practice for this project. This evidence-based practice pilot project was purposed to increase dermatology providers’ assessment of depression in patients with psoriasis. This project involved implementing a depression screening protocol at one private dermatology practice and educating providers on the use of the protocol including the embedded depression screening tool, the Patient Health Questionnaire-9. The project leader used a quasi-experimental design and collected data utilizing retrospective chart reviews completed pre- and …

Increasing Advance Care Planning In The Primary Care Setting, Nicole Marie Coffey

Doctoral Dissertations and Scholarly Projects

Evidence shows the many benefits of advance care planning (ACP) discussions, including; giving patients peace of mind, decreasing healthcare costs, increasing quality of care, and decreasing distress at the end of life. Due to the many proven benefits of ACP, the United States Department of Health and Human Services as well as many leading national health organizations are promoting ACP, even tying it to reimbursement. The best setting and time to initiate ACP is in the primary care setting as early as possible, before patients have any cognitive decline. In this context, patients have an established relationship with their provider, …

Influence Of Supportive Care On Chemotherapy Patients' Self-Care Behaviour And Satisfaction: A Pilot Study Conducted In Karachi, Pakistan, Salima Shams, Adnan Jabbar, Kashmira Nanji, Rafat Jan, Ambreen Tharani

School of Nursing & Midwifery

Background and aim: Cancer is a daunting illness affecting a vast number of people globally. During the illness trajectory, cancer patients suffer from physical and/or psychosocial issues. These physical and psychosocial issues demand conscious actions by patients to maintain their well-being. Hence, the objective of the pilot study was to evaluate the level of self-care behaviors and satisfaction in women suffering from cancer after exposure to supportive care (education and mind diversion activities) delivered via a patient help group program.
Methods: The study was conducted at the chemotherapy day care unit of one of the tertiary care hospitals …

An Educational Intervention To Raise The Awareness Of Limited Health Literacy And The Need To Utilize Recommended Strategies And Interventions Among Healthcare Clinicians In A Program Of All-Inclusive Care For The Elderly Setting, Esther Carpenter

Doctoral Dissertations and Scholarly Projects

Health literacy is a complex, common, and challenging issue facing the United States and the world today. Occurring in the context of care delivery and significantly impacting the quality of care provided, health literacy is not simply a patient problem; but places a substantial burden on healthcare clinicians to ensure they are providing clear communication. Research suggests a lack of awareness and training among healthcare clinicians related to health literacy, resulting in clinicians being unaware of and unprepared to address this issue in practice. The purpose of this evidence-based practice project was to raise the awareness of limited health literacy …

Chart Audit And Educational Provider Feedback Intervention To Improve Appropriate Use Of Spirometry In Patients With Chronic Obstructive Pulmonary Disease, Ruth Demetros

Doctoral Dissertations and Scholarly Projects

Despite being a GOLD guideline and having documented benefits, confirming a COPD diagnosis with spirometry is not routinely done. The purpose of this project was to increase patient referrals for spirometry to confirm COPD diagnosis. A quasi-experimental design was incorporated in a primary care office. A retrospective pre-intervention chart audit and two post-chart audits, 30-days apart, compared the frequency of documented spirometry to confirm a COPD diagnosis. An educational intervention with a pre and post-survey examined provider behavior intention to order spirometry to confirm a COPD diagnosis. The pre-chart audit revealed that 27/50 (54%) of patients had spirometry documented to …

Evaluating Impedance Monitoring To Reduce Hospital Readmissions For Patients With Heart Failure With Reduced Ejection Fraction: An Integrative Review, Abigail Newton

Doctoral Dissertations and Scholarly Projects

Congestive Heart Failure (HF) is a chronic progressive cardiac disorder with high mortality rates and is the number one reason for hospital readmission in the United States. More than 5 million Americans live with HF with more than 900,000 new diagnoses annually. The likelihood of developing HF increases with age making it the most common primary diagnosis for patients over age 65. HF has a significant impact on quality of life, with depression being a common comorbid condition. Thoracic impedance monitoring has shown to reduce exacerbations and hospitalizations in patients with HF. This project evaluated the literature related to impedance …

Evidence-Based Guidelines And Protocol Implementation In A Primary Care Clinic To Improve Chronic Asthma Care, Jo E. Cote

Doctor of Nursing Practice Projects

The aim of this project was to pilot the implementation of evidence-based guidelines and protocols for chronic asthma care in a rural primary care clinic system. Asthma is under-diagnosed and under-treated, resulting in significant burden of disease. Achieving asthma control requires collaborative care between the patient and healthcare clinicians. Education on evidence-based guidelines was provided to healthcare clinicians. Effectiveness of education and integration of altered workflow was measured. Integration of evidence-based guidelines and protocols was demonstrated by clinicians. The results support expanding the project to the remaining five clinics in the clinic system.

Implementation Of A Nurse Visit Model For Patients With Congestive Heart Failure In A Federally Qualified Health Center, Heather Brantley

Doctor of Nursing Practice Projects

Background: Chronic congestive heart failure is the primary cause for hospitalizations among people 65 and over in the United States, resulting in two-thirds of all heart failure costs .Congestive heart failure (CHF) continues to be one of the most prevalent and expensive chronic illnesses to treat throughout the world in a time when cost-effectiveness, improved quality, and care based on outcomes is a requirement . Chronic heart failure is the primary cause for hospitalizations among people 65 and over in the United States, resulting in two-thirds of all heart failure costs (Lambrinou, Kalogirou, Lamnisos, & Sourtzi, 2012). Traditional approaches …

Improving Patient Discharge Satisfaction Scores By Implementing Teach-Back Instructions In A Community Hospital Emergency Department (Ed): A Quality Improvement Project, Kristen Burke

Doctor of Nursing Practice (DNP) Projects

Background: Health literacy and patient satisfaction play a role in healthcare today and it is the responsibility of all providers to ensure that patients are educated about the care they received in the ED and what they should be doing upon discharge. The teach-back method ensures patients have a complete understanding of their ED stay and discharge instructions.

Purpose: The purpose of this quality improvement project was to increase patient satisfaction scores by implementing the evidenced-based, patient-centered, teach-back method for all patient education opportunities.

Methods: The DNP student led the ED leadership team and staff nurses in a quality improvement …

Best Practice Medication Reconciliation In The Outpatient Setting, Meghan J. Hession

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Medication safety is a focus of the Joint Commission’s National Patient Safety Goals and research supports improved medication reconciliation as a strategy to reduce medication errors and adverse drug events. In a busy, outpatient specialty clinic where patients are routinely considered for high-risk pharmaceutical therapies, a consistent medication reconciliation process is essential for patient safety and positive health outcomes. Purpose: To improve consistency of medication reconciliation in this high-risk outpatient setting. Method: Based on a gap analysis between evidence-based and current practice, a quality improvement intervention was implemented to increase patient engagement in the medication reconciliation process. A …

Reducing Delays In Sexually Transmitted Infections(Sti) Treatment: A Quality Improvement Project To Improve Timely Communication Among Providers And Patients, Kattie Khadar

Doctor of Nursing Practice (DNP) Projects

Abstract

Purpose: To use a nurse-communication intervention for timely provider notification of abnormal chlamydia, gonorrhea and syphilis infections, to reduce delays in treatment at a large Northeastern United States hospital. Methods: The hospital’s communicable disease report was reviewed daily, and treatment of all patients who were seen in the Infectious Disease clinic and diagnosed with chlamydia, gonorrhea and syphilis infections was monitored. Emails were sent to inform treating providers whenever a patient was not treated within 72 hours after diagnosis. Data from patients in the three months preceding was compared with data during the three months of nurse-communication intervention …

Alzheimer’S Dementia Screening In Primary Care: Quality Improvement Project To Identify Those At Risk, Kirstin Drake

Doctor of Nursing Practice (DNP) Projects

Background: Identifying Mild Cognitive Impairment (MCI) and Alzheimer’s Dementia (AD) in the Primary Care Practice (PCP) setting can initiate intervention early, before negative consequences occur including decreased quality of life and caregiver burden.

Purpose: To identify individuals at risk for AD and initiate early treatment and intervention. Methods: The Montreal Cognitive Assessment (MoCA) and Functional Activities Questionnaire (FAQ) were used as screening tools; adults age 65 and older were participants.

Implementation Procedure: Within the Internal Medicine Clinic, the standard annual wellness visits include Registered Nurses that administer a Mini-Cog screening tool with the patients. The Mini-Cog is a brief …

Hepatitis C Virus Education For Nurse Practitioners In Primary Care, Michele Broskey

Doctor of Nursing Practice (DNP) Projects

Purpose: The object of this Quality Improvement (QI) project was to appraise the effectiveness of a web-based education resource for APN’s knowledge of HCV recommendations.

Methods: An educational intervention was conducted for APNs working in primary care medicine to increase provider knowledge of screening, diagnosing and management of viral Hepatitis C which utilized a web-based provider-specific curricula. A pre-test and post-test survey was used to assess the APN’s Knowledge, Attitude and Practices (KAP) regarding the current published evidence. Continuing education credits and small financial incentives were offered for participation. The curriculum was evaluated by an Infectious Disease expert APN.

Results: …

Improving Patients' Understanding Of Their Electronic Medical Record Data In Order To Improve Self-Management - A Quality Improvement Project, Erin Amelia Roth

Doctor of Nursing Practice (DNP) Projects

Background: Patients are increasingly given access to their electronic medical records (EMRs) to help them keep track of their care, but many may have a difficult time understanding what is in them. Programs such as NoteAid assist in translating medical records and may increase the number of patients who actively use their EMRs, a development which may improve the management of chronic diseases.

Purpose: To work on a translation system developed by the University of Massachusetts Informatics group to make outpatient records more understandable for adult patients with chronic disease by using and testing a machine-learning database (NoteAid). Patients’ self-management …