Utilization Of Organ Inventories In The Primary Care Setting: Two Questions To Increase Usage, Siobhan A. Lister

DNP Projects

Background: The Transgender and Gender Diverse (TGD) population experiences significant health disparities in accessing preventative care when compared to their cisgender counterparts. These disparities often occur with organ-specific screenings and lead to poorer health outcomes, due to patients having organs that do not match their sex assigned at birth. The evidence recommends a two-question method of gender identification to identify those patients whose gender does not match their sex assigned at birth. Using the 2-question method can help identify patients who need an organ inventory completed, which will lead to appropriate preventative health screenings being done.

Purpose: The purpose was …

Evaluating The Outcomes Of An Educational Intervention For Providers And Two-Week Home Blood Pressure Monitoring In Adults, Michelle Ann Schuler

DNP Projects

Abstract

Background: Approximately 1.28 billion adults worldwide have hypertension (HTN), which greatly increases the risk of morbidity and premature death. Home blood pressure monitoring (HBPM) has been shown to increase efficacy of treatment decisions, but is underused in primary care. About 46% of adults are unaware that they have hypertension and only about 21% of those who have been diagnosed have it controlled.

Purpose: The purpose of this project is to evaluate a previous practice improvement project and improve the HBPM process for sustainability.

Methods This HBPM study utilized a retrospective study design combined with a practice improvement project …

An Evidence-Based Practice Initiative To Improve Blood Pressure Control, Teresa D. Hines

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction/Background: High blood pressure (HBP) is a significant public health concern. It affects millions of adults in the United States (US) and half of the adult population in the Appalachia regions. High blood pressure is a known risk factor for cardiovascular disease (CVD), which is the leading cause of morbidity and mortality Appalachia. Complications associated with high blood pressure result in substantial economic burdens for patients and their families, healthcare systems, and national economies. High blood pressure is a significant health issue in West Virginia (WV), with an estimated 602,000 people suffering from HBP.

Purpose: The purpose of this …

Promoting Confidence And Evidence-Based Practices For Attention-Deficit/Hyperactivity Disorder Among Integrated Primary Care Providers: A Qualitive Improvement Education Initiative, Omar Samateh, Margaret Emerson, Kayla Meisinger, Taylor Wilson, Leeza Struwe

Doctor of Nursing Practice Projects: College of Nursing

Introduction: Primary Care Providers (PCPs) are seeing growing number of patients presenting for adult attention-deficit/hyperactivity disorder (ADHD) evaluations as a result of social media influences highlighting ADHD. Yet, PCPs report lacking confidence and education with adult ADHD. The purpose of this quality improvement study was to develop educational materials to promote confidence, competence, and adherence to ADHD evidence-based recommendations among integrated care PCPs. Methods: A literature review and retrospective chart review of 19 patients were used to create 1) Baseline ADHD Provider Education (PE) tool, 2) Standardized ADHD Diagnosis (SAD) referral process, 3) ADHD Assessment, Treatment, and Monitoring …

Improving Immunization Rates In Children Under Two Years Of Age In Linn County, Kansas Through Nursing Education, Heather L. Webber

Doctor of Nursing Practice Scholarly Project

Immunizations are one of the most beneficial preventive health measures available to children under two years of age. Failing to receive these preventative immunizations during these crucial years could result in the child developing serious diseases that may lead to long term disability or even be fatal. By increasing immunization rates, children will be more protected against common childhood diseases which will allow them to grow and thrive. The purpose of this scholarly project was to identify ways to improve vaccination rates in children under two years of age at specific clinics in Linn County, Kansas, using healthcare professional education. …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

Improving Diabetes Self-Management Skills Among Adults With Type 2 Diabetes Through Weekly Education, Carthia Joachim

Dissertations

Type 2 Diabetes Mellitus is one of the major health issues worldwide, which has led to many health complications, such as cardiovascular disease, nerve damage that leads to limb amputation, kidney damage, and even death (Sameer et al., 2020). Lack of self-care management is one of the reasons diabetes is becoming such an issue in society. Studies have shown that T2DM outcomes can be improved by implementing diabetes self-management education (DSME) (Hailu et al., 2019). The study evaluated the effectiveness of DSME intervention in adult patients with T2DM over 12 weeks in Orlando, Florida. Using a structured education program, the …

Effectiveness Of Eucalyptus For Pain Management: An Integrative Review, Taylor Stone, Jennifer Tran

Master's Projects

This integrative review examines eucalyptus essential oil effectiveness for pain, particularly as an alternative to opioids. An extensive literature search was conducted across multiple databases, including Joanna Briggs Institue, Cochrane, CINAHL, PubMed, and Scopus, focusing on studies examining eucalyptus oil’s analgesic properties, along with its effectiveness when used alone or in conjunction with complementary therapies like massage and acupuncture. Analysis identified three key themes: (1) the effectiveness of eucalyptus oil in pain reduction across various acute and chronic pain conditions, (2) its role in potentially reducing reliance on pharmaceutical pain relief, and (3) its capacity to enhance the effectiveness of …

Relationship Of Stress, Family, And Social Support, And Job Satisfaction To Burnout Among Family Nurse Practitioners Employed In Primary Care Clinics In Mississippi, Laura-Jean Scott Brooks

Dissertations

In the realm of healthcare, burnout is the invisible monster that has infiltrated every facet of the industry with grossly visible results. From provider turnover to patient errors, burnout has lifelong effects on the healthcare provider and patient care. This researcher seeks to study variables and the relationship to burnout among Family Nurse Practitioners who practice in primary care in Mississippi. The Review of the Literature demonstrated a lack of findings in burnout among family nurse practitioners. Most of the literature reviewed focused on burnout among registered nurses. The guiding hypothesis of the research study was that social and family …

Reducing Congestive Heart Failure Readmissions Through Discharge Planning And Education, Coewonda Burse

Doctoral Projects

Chronic heart failure (CHF) is a widespread problem among individuals, which, at the same time, consumes a considerable share of global healthcare demand. CHF management poses a persistent issue mainly due to the short interval of hospital readmissions four weeks after discharge, which indicates deficiencies in care transitions and patient education. This doctoral project addresses this topic and evaluates whether implementing patient-specific education and discharge planning programs can decrease CHF-associated hospital readmissions. To investigate the phenomenon, the DNP student completed a retrospective chart review, found an intervention, implemented said intervention, and then evaluated the intervention's effectiveness versus interventions already in …

Prescription For Change: Tackling Inappropriate Antibiotic Use In Urgent Care Settings, Lachundra Mosley

Doctoral Projects

A pressing global health issue that significantly contributes to antibiotic resistance is the inappropriate antibiotic prescribing for Upper Respiratory Infections (URI’s) in urgent care settings (World Health Organization [WHO], 2022). The purpose of this doctoral project was to reduce inappropriate antibiotic prescriptions for URI at an urgent care in D’Iberville, Mississippi through the implementation of an educational pamphlet.

A pre-post intervention project was conducted, collecting data on antibiotic prescribing practices via retrospective chart reviews before and after the educational intervention. Data was collected using a researcher developed screening tool based on Evidence based guidelines to distinguish viral vs bacterial infections. …

Obstructive Sleep Apnea And Obesity: How Weight Loss Improves Sleep Apnea Severity And Quality Of Life - An Integrative Review, Hannah Wilson, Neda Akbarshahi

Master's Projects

Introduction: With the growing prevalence of OSA due to the obesity epidemic, there is an urgent need to update treatment regimens. While CPAP continues to be the gold standard of OSA care, challenges with adherence and limited access to effective weight management strategies often impede care. The complex bidirectional relationship between obesity and OSA highlights the importance of addressing weight management in this patient population to help mitigate cardiometabolic risks. Personalized weight loss therapies should be integrated into standard OSA treatment regimens to reduce OSA severity, reduce comorbid conditions, and improve quality of life.

Aim: The objective of this integrative …

Munchausen Syndrome By Proxy Presentation, Giovanna Tomassoni, Meredith Mackenzie

Master's Projects

Munchausen syndrome by proxy (MSBP) is a serious form of child abuse in which the perpetrator is typically the victim’s maternal caregiver. Assessing for MSBP can be very challenging for medical providers due to symptom mimicry and a dearth of information about the disorder. This Integrative Review seeks to shine a light on common symptomatology of MSBP and to make sure that providers leave it on the differential diagnosis until alternative diagnoses can effectively exclude it. A total of 240 records from online databases were reviewing for content, currency, and rigor. This search was narrowed to 10 records for in-depth …

Advance Care Planning In Rehabilitation: Training Nurses And Social Workers To Facilitate Discussions, Celeste Christiansen

Student Scholarly Projects

Practice Problem: Patients and healthcare workers fail to hold advance care planning (ACP) discussions. Social workers perceive a lack of time and feel unprepared to hold ACP conversations.

PICOT: The PICOT question that guided this project was: Do patients in acute inpatient rehabilitation (P) who receive education and resources about ACP from trained nurses and social workers (I) accept and participate in ACP (O) compared to prior standards of care (C) while on the rehabilitation unit (T)?

Evidence: The public and healthcare workers have limited knowledge of ACPs and their role in these discussions. People are more likely to hold …

Evaluating An Evidence-Based Quality Improvement Initiative For Food Insecurity Screening And Referral In Adults With Diabetes Initiating Continuous Glucose Monitor Therapy, Coni Dennis

Graduate Theses, Dissertations, and Capstones

Diabetes affects 37 million people annually in the United States, with direct medical costs exceeding $237 billion per year (American Diabetes Association, 2018; Xu et al., 2018). Complications account for up to 64% of diabetes-related expenses, emphasizing the importance of glycemic stability in preventing costly and debilitating outcomes (Dieleman et al., 2016). Diet and nutrition, essential for glycemic control, are often undermined by food insecurity—defined as inconsistent access to adequate, nutritious food—affecting 16% of adults with diabetes (Casagrande et al., 2022; Kirby et al., 2021). Food insecurity is linked to higher HbA1c levels, increased complications, and hospitalizations (Thomas et al., …

Best Practice Toolkit For Increasing Colorectal Cancer Screenings In At-Risk Adults, Zoe Windfelder

Student Scholarly Projects

Adult individuals at risk for colorectal cancer (CRC) do not have a direct, accessible best-practice toolkit to follow for screening measures. Research showed that at least three guidelines (i.e., American Cancer Society [ACS], American College of Gastroenterology [ACG], and U.S. Preventive Services Task Forces [USPSTF]) are used interchangeably daily by interprofessional staff for individuals with average to high-risk variables. The project was guided by the following PICOT question: For interprofessional staff supporting the at-risk adult population for colorectal cancer (P), how does the development of a best practice for coordination of care toolkit (I) compared to no structured program strategy …

Effect Of Telehealth Interventions On Hypertension Management In A Veterans Affairs Community-Based Outpatient Clinic (Cboc), Cherilyn Schumacher

Student Scholarly Projects

Practice Problem: Per U.S. Department of Veterans Affairs (2020), hypertension (HTN) is prevalent in active and retired military personnel with 13% of those in active duty and in “more than one in three Veterans…making it the most common chronic condition for Veterans” (p. 1). Per the Electronic Quality Measure (eQM) portal, a PACT clinic in a CBOC is scoring well below the national and facility benchmarks, showing a need for an intervention that will improve HTN management.

PICOT: For current veteran patients ages 18-85 assigned to a PACT (P), what is the effect of nurse-led telehealth blood pressure …

Evaluation Of A Primary Care Community Health Center’S Mammogram Program In Relation To Current Evidence-Based Practice., Brianna Childress

Doctoral Dissertations & Projects

Breast cancer is the second leading cause of cancer deaths among women over 50 years of age. Although mammograms have been proven to be effective in early detection of breast cancer, compliance rates are declining in the United States making it an objective for Healthy People 2030 to achieve and maintain a national compliance rate of 80.3%. For early detection of breast cancer among women between 50 to 74 years old to occur, an effective breast cancer screening program is vital. To understand why mammogram compliance rates were below the national average at a primary care community health center in …

Interventions Aimed To Reduce Hospital Admissions In Patients With Cardiovascular Disease Related To Substance Use Disorder, Hannah Lambert, Kayla Landaverde

Master's Projects

Heart failure (HF) and substance use disorder (SUD) are both growing epidemics in the United States. When combined, patients with concurrent substance abuse and heart failure may present with various cardiac complaints such as chest pain, hypertension, and shortness of breath. There are little to few studies specifically evaluating interventions for decompensated heart failure to counteract the rising rates of cardiovascular issues associated with SUD. This review aims to investigate the effects of interventions targeted to prevent hospital readmission in patients with congestive heart failure associated with substance use disorder. An integrative review methodology was applied to gain an inclusive …

Mental Fatigue And Self-Care In Informal Oncology Caregivers: A Descriptive Mixed Methods Study, Megan Wayne

MUSC Theses and Dissertations

Purpose:

This dissertation study aimed to enhance understanding of informal caregiver wellbeing by exploring the presence of mental fatigue, the relationships among mental fatigue, self-care, and informal oncology caregiver quality of life (QOL), and determining whether differences exist in self-care engagement and QOL between caregivers who report high and low levels mental fatigue.

Problem:

Healthcare is becoming increasingly reliant on informal caregivers for the management and care of individuals with serious illnesses such as cancer. Previous research has shown that informal caregivers routinely experience many negative effects as a result of providing care including decreased mental health and …

Enhancing Clinical Staff Knowledge And Skills In Ankle-Brachial Index (Abi) Measurements: A Training Intervention Study In A Small Family Medicine Clinic, Christopher Avellanet Manzano

Doctor of Nursing Practice Projects

Background

Peripheral arterial disease (PAD) is a common yet often underdiagnosed condition that can lead to serious complications. This study aimed to evaluate the impact of an Ankle-Brachial Index (ABI) education training program on clinical staff's referral rates, accuracy in performing ABI measurements, knowledge regarding PAD, and confidence levels in a small family medicine clinic in Dallas.

Method

The study utilized a pre- and post-intervention design. Clinical staff participated in a structured ABI training program, after which referral rates to vascular specialists were measured alongside evaluations of accuracy, knowledge, and confidence levels. The paired t-test was employed to analyze the …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Comparing Costs And Predictors Of Low-Value Healthcare Service Use Among Primary Care Nurse Practitioners In The Southwest United States, Sara B. Nugent

Nursing ETDs

Low-value healthcare services (LVHSs) are unsupported by current evidence, associated with harmful patient outcomes, and equate to over $100 billion in wasteful spending annually. The aims of this descriptive, comparative study were to establish baseline prevalence and costs associated with LVHS use among primary care nurse practitioners (NPs), and to test the influence of different geographical regions and patient populations. A secondary data analysis of the Merative™ MarketScan® 2021 databases was conducted. LVHS prevalence was lower or fairly equal to that of other studies, and direct claim costs were very-low cost. Extremely high low-value lumbar radiographic imaging claim costs were …

Trauma-Informed Care: A Therapeutic Approach In Communication, Nicole A. Leonce

DNP Qualifying Manuscripts

As medical providers, it is crucial to use therapeutic communication when building relationships with patients. Bias, stigma, and judgment often manifest through a provider’s body language and choice of words, exacerbating patient trauma and leading to health disparities. Trauma-informed care (TIC) addresses these issues by emphasizing respect, compassion, and empathy. TIC has been extensively studied in high-income regions such as Australia, Europe and the United States, but its application in low- and middle-income countries (LMIC) such as Kenya, is less understood. The aim of this study was to assess the knowledge, attitudes, and skills of nurses working in a rural …

A Cross Cultural Comparison Of Adolescent Sexual Socialization In Family Settings In Four Thai Regions: A Cross Sectional Survey, Ampornpan T้Heeranut, Pongdech Sarakarn, Donlagon Jumparway, Arina Abdulloh, Piches Ruangsuksud, Chaiyun Sakulsriprasert, Bhunyabhadh Chaimay, Linda L. Shield, Alison Hutton, Kesinee Saranrittichai

Journal of Health Research

Background: Sexual socialization is different across cultural contexts due to norms and values including adolescents’ growth & development and characteristics. Patterns of sexual socialization across different cultural contexts and adolescents in Thailand are still unknown. This analytical cross-sectional study aimed to explain and compare 5 patterns of adolescent sexual socialization in Thailand (SSFA): trust, strict, exhaust, review, and general patterns.

Methods: The sample included 1,050 parents living in the same house with their adolescent offspring aged 13-19 years. Stratified cluster randomized sampling was performed to access participants. The instrument used for measuring adolescent sexualization in families with adolescents was …

Evaluation Of An Advanced Practice Clinician Onboarding Program, Sophia Robinson

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of a mentorship-based onboarding program versus a standard program without mentorship.

PICOT: The PICOT question that guided this project was (P), In newly hired APCs did the inclusion of mentorship in the onboarding process (I) lead to higher levels of general self-efficacy compared to standard orientation practices lacking mentorship (C), within an 8-week timeframe (T)?

Evidence: Nine articles were reviewed, revealing that standardized mentorship, structured orientation, and tailored support for professional development are critical strategies to boost confidence and retention among healthcare professionals.

Intervention: A standardized onboarding program that incorporated …

Increasing Breast Cancer Screening Rates Among Women Ages 40 To 74 In An Urban Safety Net Primary Care Clinic: A Quality Improvement Project, Wilder Pinnock

Doctor of Nursing Practice Scholarly Projects

Background and Problem Description: Breast cancer continues to be the most common and second most lethal form of cancer among women in the U.S. Although there have been improvements in breast cancer screening in the US, major disparities persist. The national breast cancer screening rate for the year 2021 was 75.6%; the rate for the underserved and minority population was 54%. This QI project took place at a Federally Qualified Health Center that provides medical care to medically underserved and vulnerable populations.

Purpose and Aim: This project aimed to increase breast cancer screening at the proposed site to optimize early …

Interdisciplinary Medication Reconciliation Approach For Arabic-Speaking Patients, Rebecca Rodman

Dissertations

Abstract

Problem: Limited English Proficiency (LEP), which includes Arabic speakers, presents challenges in healthcare and can impact medication reconciliation and adherence. Interdisciplinary collaboration involving patients and interpreters is crucial for improving medication reconciliation and adherence. This project aimed to examine the impact of an interdisciplinary medication reconciliation approach on medication adherence with Arabic-speaking patients ages 18-99 over three months.

Methods: This quality improvement (QI) pilot project utilized a descriptive cohort design. A translated validated Morisky, Green, and Levine (MGL) adherence survey consisting of four questions was administered pre- and post-implementation to a convenience sample of Arabic-speaking patients 18 years …

Implementation Of Home Blood Pressure Monitoring, Sarah Gutzke

Dissertations

Approximately 48.1% of adults in the United States have high blood pressure. Providers may encourage patients to monitor and log their blood pressure at home. Still, patients often fail to bring this information to appointments, leading to reliance on less comprehensive in-office measurements. This quality improvement project aimed to increase adherence to home blood pressure logs using a Blood Pressure Toolkit. A descriptive, observational design was utilized to record patient adherence of taking home blood pressure measurements and increase the number of patients who brought their blood pressure logs to their healthcare provider visits over two months. A convenience sample …