Nursing Commons^™

Evaluation Of A Smoking Cessation Program In Primary Care, Yolanda Duncan-Watt

Dissertations

Abstract

Problem: The adult tobacco smoking rate exceeds 12.5%. The problem is the insufficient attention given to smoking cessation education in low socioeconomic status(SES) communities. There is a lack of access to and awareness of smoking cessation programs for low-income populations.

Methods: This quality improvement (QI) study will use a descriptive, observational approach. A retrospective medical record review will be conducted to determine the rate of individuals who got the smoking cessation intervention and the rate of those who successfully quit one month after the intervention. Data was collected throughout the spring of 2024, during primary care visits and phone …

Improving Transitions In Care Through Early Discharge Planning: A Quality Improvement Initiative., Sarah Markgraf

Doctor of Nursing Practice Papers

Background: A substantial body of evidence has shown transitions in care are one of the weakest links in healthcare networks, especially for older adults with complex comorbidities. Residents receiving short-term rehabilitation (i.e., rehab) transitioning to home from a skilled nursing facility (SNF) are the most vulnerable in the first 30 days post-discharge for adverse resident events, including avoidable rehospitalization. Avoidable rehospitalizations cost Medicare billions of dollars annually and lead to poor resident outcomes. Early discharge planning in SNFs for short-term stay rehabilitation has decreased rates of avoidable rehospitalizations, improved quality of life in geriatric residents, and improved care partners' perceived …

Implementing Bedside Shift Reporting On An Adult Medical-Surgical Unit: An Evidence-Based Intervention For Inpatient Fall Reduction, Halie Blackerby

Doctor of Nursing Practice Projects

Background: Patient falls are a continuous issue in healthcare facilities because they increase patient length of stay and hospitals receive no reimbursement for these falls from insurance providers. Falls are a patient safety issue and can result in long-lasting damage for patients in the healthcare facility, including fear of ambulation. Falls in a facility can impact a facility’s ability to meet strategic planning goals and receive state and federal funding.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement project aimed to reduce inpatient falls during shift change by implementing an evidence-based bedside shift reporting (BSR) protocol.

Methods: Quantitative data …

A Quality Improvement Project: Improving The Clinical Practice For Assessing Hemoglobin A1c On Admission In Diabetic Ketoacidosis Patients Admitted To The Intensive Care Unit, Tiara Lawson

Doctor of Nursing Practice Projects

Background: Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. Early treatment and adherence to guidelines are crucial in preventing DKA. The American Diabetes Association (ADA) publishes annual guidelines for effective DKA management, and the Education Recognition Program National Benchmarks program can help maintain adherence to the published guidelines. Improving the intensive care unit (ICU) admission process enhances the quality of care to DKA patients and improves progress towards national benchmarks.

Purpose: This quality improvement project aimed to improve Hemoglobin A1C (HbA1c) evaluations in DKA patients admitted to the ICU.

Methods: The intervention of triggering HbA1c orders …

A Quality Improvement Project To Reduce Facility-Acquired Pressure Injuries, Carolina Rosario

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Facility-acquired pressure injuries (FAPIs) pose significant risks to patient outcomes and healthcare costs ($500 to $70,000 per PI) in subacute rehabilitation (SAR) facilities. An assessment in a SAR identified a concerning pressure injury (PI) rate of 15.3%, exceeding the national benchmark of 10% for such facilities. This prompted an evidence-based quality improvement (QI) initiative.

Aim of the Project: This project aimed to reduce FAPI rates by 30% or greater among patients 65 and older using a PI prevention bundle called SSKINS (Skin, Surface, Keep moving, Incontinence/moisture, Nutrition/hydration, Self-management).

Review of the Evidence: A comprehensive literature review indicated that PIs …

Improving Obesity And Related Chronic Disease Outcomes: Developing Nurse Practitioner Competence In Motivational Interviewing, Jodi Wilson

Doctor of Nursing Practice Final Manuscripts

Background: Despite America’s persistent focus on health, over 40% of the US population is obese. A significant obstacle to mitigating disease in those with obesity is inspiring lasting behavioral change. Motivational Interviewing (MI) is highly effective yet under-utilized for catalyzing personal change inertia. Recent meta-analyses demonstrated statistically significant improvement in BMI, A1C, and blood pressure. Objectives: This evidenced-based project (EBP) aimed to develop nurse practitioner (NP) skills in deploying fidelity-based MI, resulting in increased adherence to lifestyle interventions. Implementation: This EBP project implemented MI into routine primary care through a self-paced healthcare provider MI certification and a 45-minute skill …

An Integrated Review: Outpatient Care And Management Of Fever And Neutropenia Among The Pediatric Oncology Population, Sarkis Makarovich

DNP Qualifying Manuscripts

Abstract

In the pediatric population, comprehensive cancer treatment and its associated side effects significantly impact their physical and emotional well-being. Though chemotherapy drugs are valuable agents against cancer cells, they also damage healthy dividing cells, such as bone marrow, thus weakening the immune system. Febrile neutropenia (FN) and associated infections remain the most critical complications of the extensive chemotherapy regimen and can threaten life if not appropriately addressed. Appropriate primary evaluation and treatment of FN in children with cancer includes administering proper broad-spectrum antibiotics. Ongoing research has focused on improving quality of life (QoL); yet, FN has persisted as the …

Nurse-Led Telehealth Visits For Patients With Multiple Sclerosis During The Covid-19 Pandemic And Beyond, Eun Hye Kim

Doctor of Nursing Practice (DNP) Projects

Background: Nearly one million individuals are affected with Multiple Sclerosis (MS) in the United States, and it was estimated the annual economic burden of multiple sclerosis in the U.S. at over $85.4 billion in 2022.

Problem: During the outbreak of COVID-19, the number of nurse-led patient education sessions has decreased due to the conversion of in-person clinic visits to telehealth visits. Despite the widespread use of telehealth for MS patients post-COVID-19 pandemic, limited data is available about the use of nurse-led telehealth visits with a standardized workflow.

Method: A quality improvement project was implemented at the MS clinic in Northern …

Education For Primary Care Providers On Advance Care Planning, Lindsey Ward

Doctor of Nursing Practice (DNP) Projects

Background: Advance care planning (ACP) is a discussion of a patient’s end-of-life healthcare wishes. Its purpose is to indicate these wishes clearly should the patient be unable to make their decisions known to providers and family members due to a sudden health decline or medical emergency. Healthcare providers, specifically nurse practitioners, physician assistants, and physicians in the primary care setting, are well-positioned to facilitate these conversations with their older adult patients. However, research states that limited provider knowledge of and confidence in implementing ACP are significant barriers to its application in practice.

Problem: At a primary care clinic in Midtown …

Development Of An Endometriosis Toolkit To Support Clinicians In Providing Quality Care For Women, Rachel Hasbun

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Endometriosis is the abnormal growth of endometrium-like tissue outside the uterine cavity, affecting approximately 11% of women in the United States during their reproductive years. Diagnostic challenges stem from its varied clinical presentations, reliance on laparoscopy for definitive diagnosis, and limited awareness among practitioners and patients, potentially leading to diagnostic delays of up to 13 years.

Problem: The complexities of diagnosing endometriosis in primary care and specialty settings, combined with limited provider awareness and a lack of comprehensive resources, hinder timely and accurate identification. This leads to suboptimal treatment and care for women affected by the condition.

Methods: …

Utilizing Decision Tree Implementation And Provider Education To Improve Colorectal Cancer Screening Orders: A Quality Improvement Project, Alicia Kollar

Doctor of Nursing Practice (DNP) Manuscripts

Background and Significance: Colorectal cancer (CRC) is the third most common cancer and the second leading cause of cancer-related deaths (Jain, et al., 2022). Healthy People 2030 objectives include reducing the CRC death rate and increasing the proportion of adults who get screened (Healthy People 2030, n.d.). According to 2021 data, only 58.7% of adults are screened with a Healthy People target of 68.3%. Healthy People states that there are effective screening tools to detect colorectal cancer early, and people are more likely to survive it (Healthy People 2030, n.d.). Purpose: This quality improvement (QI) project aims to implement an …

Identify And Overcome The Barriers Of Care From A Patient And Provider Perspective In Adult Patients With Type 2 Diabetes Mellitus In A Federal Qualified Health Clinic: A Quality Improvement Project, Jill Miscovich

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes is a significant healthcare issue that not only effects the United States but also has a global impact, it is costly for the workforce and to manage. Diabetes management is more complex in rural areas due to increased SDOH and barriers to care. The purpose of this quality improvement (QI) project is to identify and overcome the barriers to care from the patients and nurse practitioners’ (NPs) perspectives in adult patients with type 2 diabetes mellitus (T2DM) in a rural federal qualified health clinic (FQHC). A mixed method approach was used including qualitative and quantitative data project manager created …

Identify And Overcome The Barriers To Care From A Patient And Provider Perspective In Adult Patients With T2dm In A Rural Federal Qualified Health Clinic (Fqhc): A Quality Improvement (Qi) Project, Jill Miscovich

Doctor of Nursing Practice (DNP) Manuscripts

Diabetes is a significant healthcare issue that not only effects the United States but also has a global impact, it is costly for the workforce and to manage. Diabetes management is more complex in rural areas due to increased SDOH and barriers to care. The purpose of this quality improvement (QI) project is to identify and overcome the barriers to care from the patients and nurse practitioners’ (NPs) perspectives in adult patients with type 2 diabetes mellitus (T2DM) in a rural federal qualified health clinic (FQHC). A mixed method approach was used including qualitative and quantitative data project manager created …

Low Vitamin B12: The Need For Updated Provider Education, Tracy Coltharp

Doctor of Nursing Practice Scholarly Project

Vitamin B12 deficiency is a notable clinical problem with multi-factorial risk factors and a multitude of clinical manifestations. It is associated with polyglandular autoimmune syndromes, some familiar and some lesser well known. The specific aim of this scholarly project was to evaluate whether education aimed at providers such as nurse practitioners, nurse practitioner students, physician assistants, and physicians regarding updated diagnostic criteria for vitamin B12 deficiencies as well as associated diseases, specifically autoimmune gastritis, and pernicious anemia, increased their knowledge and ultimately improved clinical practice. The project utilized a pre-test/post-test design with education provided in between. There was an improvement …

The Effect Of Education Path And Nursing Specialty On Knowledge And Attitude Survey Regarding Pain Scores, Justin Cope

Doctor of Nursing Practice Scholarly Project

Pain is reported as the number one fear of patients, and has been shown to stop patients from seeking necessary medical treatment in a timely manner. Therefore, it is important that health care professionals be able to properly assess and treat pain. One area not previously studied is how degree path affects knowledge acquisition.

The purpose of this study is to determine the effect of structured education and clinical experience on general pain knowledge between traditional and non-traditional Bachelors of Science in Nursing students. Participants of this study include RN-BSN students and pre-licensure BSN students who have completed the Adult …

Addressing Stroke Care Disparities Through Patient Education, Christina Annerino

Honors Capstones

It has been found across current studies and evaluations of stroke care and patient outcomes that there is a disparity in disability and mortality between male and female patients who have experienced stroke. The aforementioned studies did not identify the cause of this disparity, although a number of hypotheses for this phenomenon were provided. This study then conducted a preliminary survey of 130 participants, both men and women, aged 18-80 years old, to evaluate potential barriers to accessing stroke care and receiving treatment effectively. Preliminary survey data demonstrated consistent gaps in knowledge related to stroke risks, stroke symptoms, and when …

Implementing An Insomnia Assessment And Management Algorithm In A Rural Pirmary Care Clinic, Rebekah Gaffin

Doctor of Nursing Practice Projects

Insomnia is the most common sleep complaint and significantly impacts quality of life and productivity. The accumulated total of direct and indirect healthcare costs related to insomnia is estimated to be as high as $100 billion/year and is associated with an increased risk of cardiovascular and cerebrovascular disease. Primary care providers play a critical role in identifying and implementing early interventions to address insomnia. However, this can be time-consuming, and providers may be unaware of the latest treatment guidelines and available resources. This project provided a research-based algorithm to identify and initiate treatment for patients 18+ with chronic insomnia in …

Using Readiness To Change For Dietary Modification In A Rural Primary Care Setting, Rebecca Johnson Beller

Theses & Dissertations

Cardiovascular disease is a prevalent noncommunicable disease. Modifying lifestyle behavior can decrease cardiovascular disease morbidity and mortality outcomes. This dissertation's purpose was to explore behavioral change interventions with dietary strategies to reduce cardiovascular disease rates. The integrative review explored aspects of dietary strategies in the primary care setting. Despite the importance of diverse studies, comparing all the components results in limited generalizability. In the following chapter, a cross-sectional study elicited healthcare professionals’ perceptions of the usefulness of a readiness for lifestyle change tool in clinical practice. Currently, a common, widespread adoption of a readiness for lifestyle change tool is not …

Addressing Air Quality Mitigation As A Key Factor In Asthma Management And Prevention, Julia Buckles, Jewel Radford

Doctor of Nursing Practice Projects

Asthma is the most prevalent disease in childhood and disproportionately affects African American (AA) populations in terms of prevalence and frequency of exacerbations. Air quality and environmental factors are strongly associated with the diagnosis and management of asthma and AA children are more likely to live in areas with poor air quality. An air quality flag program was implemented in a daycare located in a county with a predominantly AA population with a high prevalence of asthma diagnoses. The goal of the intervention was to increase staff awareness of air quality and the impact it can have on asthma diagnosis …

Implementation Of A Validated Suicide Screening Tool In A University Student Health Center, Tessa Welniak, Bailey Coslor, Cathrin Carithers

Doctor of Nursing Practice Projects: College of Nursing

Purpose. Suicide is the second leading cause of death among adults in the United States and Nebraska. Death by suicide impacts millions of adults every year in the United States but warning signs are often missed during visits with primary care providers. The University of Nebraska at Kearney (UNK) Student Health Center (SHC), like many other primary care clinics, did not routinely screen patients for suicide risk. According to the Joint Commission, all patients over 12 years of age should be screened for suicide using a validated screening tool if the visit is for any behavioral health concern. The project’s …

Increasing Human Papillomavirus Vaccine Uptake In Primary Care Using The 4 Pillars Program: A Quality Improvement Project, Hannah Lyons

The Eleanor Mann School of Nursing DNP Capstone Projects

Aim: To explore the effectiveness of the 4 Pillars Program on increasing human papillomavirus vaccination use in patients ages 9-18 years.

Design: A retrospective quasi-experimental research design comparing pre- and post-implementation human papillomavirus vaccination rates.

Keywords: human papillomavirus, vaccination, pillars, program, communication, tool, quasi-experimental, retrospective

Methods: A retrospective chart review identified the rate of encounters per provider where the human papillomavirus vaccine was administered to patients ages 9-18 years. Interventions including increasing access to the vaccine, standardizing provider recommendation of the vaccine, enhancing utilization of the electronic health record, and introducing a vaccine champion, known as …

Addressing Social Determinants Of Health In Medication-Assisted Treatment Programs, Audrey Hunter

The Eleanor Mann School of Nursing DNP Capstone Projects

Introduction: Medication-assisted treatment (MAT) is considered the most effective treatment for patients with opioid use disorder (OUD); however, MAT program retention rates are consistently low across the United States. Addressing social determinants of health (SDOH) through text message could impact MAT retention; therefore, a pilot project at a federally qualified healthcare center (FQHC) was implemented.

Methods: The Protocol for Responding to and Assessing Patients’ Assets, Risk, and Experiences (PRAPARE) SDOH screening tool was implemented for patients undergoing MAT for OUD. Community resource referrals were provided via text message based on the screening results. Retention in treatment was measured by prescriptions …

The Impact Of Authoritative Parenting Compared To Authoritarian And Permissive Styles On Long-Term Psychological And Behavioral Function Of Offspring., Brooke Washington

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Different parenting styles produce specific traits in offspring that are of direct relation to the chosen parenting style of the household. The goal of this study is to answer the question: What is the impact of authoritative parenting compared to authoritarian and permissive styles on long term psychological and behavioral function of offspring? This systematic review was conducted to collect and analyze studies relating to the long-term psychological and behavioral effects of offspring who were raised in one of the three most common parenting styles practiced: authoritative, authoritarian, and permissive. The authoritative parenting style is classified as establishing a warm, …

Utilization Of The Reproductive Justice Framework In Contraceptive Counseling With Black And African American Women: A Comparison Of Patient Satisfaction And Provider Knowledge, Simranjeet K. Tagore

Doctoral Projects

Current practice in contraceptive counseling is characterized by great variation in both content and implementation. The literature indicates that African American women desire contraceptive counseling based in respect, trust, and equity. Conducted over 8 weeks, this quality improvement project compared satisfaction in African American and Black patients receiving contraceptive counseling by a provider trained in the Reproductive Justice Framework (RJF) versus those receiving contraceptive counseling by a provider not trained in the Reproductive Justice Framework. This project also evaluated the effects of Reproductive Justice Framework training on clinician knowledge. Inclusion criteria for the patients included identifying as Black and/or African …

Evaluation Of An Emergency Department Provider Information Update On The Initiation Of Suboxone With A Community Treatment Program Referral For Opioid Overdose And Opioid Use Disorder, Carmen Brewington

All Dissertations

Over 21 million people in the United States (U.S.) require substance use disorder (SUD) treatment; yet less than 4 million people receive treatment (Bressan & Kening, 2023). According to Thomas et al. (2022), opioid overdose deaths are increasing, and improving access to evidence-based treatment is critical. Hospital emergency departments (EDs) play a lifesaving in the emergency treatment of opioid overdoses; but can also serve as gateways to opioid treatment by healthcare providers for opioid addictions (Reuter et al., 2022). Mortality, after an ED visit for opioid overdose, is high (Thomas et al., 2022). Community resources are limited, thus making it …

Pneumococcal And Influenza Vaccine Co-Administration In The Incarcerated Population, Kaitlyn Stroh

Doctor of Nursing Practice Projects

Background/Significance: Streptococcus pneumoniae is responsible for 20-60% of U.S. bacterial pneumonia cases and has a mortality rate of 10-30%. Invasive pneumococcal disease (IPD) occurs when streptococcus pneumoniae invades otherwise sterile sites. Adherence to immunization guidelines is 60-70% effective at preventing IPD. Co-administration of pneumococcal and influenza vaccines has shown promise at increasing uptake of the pneumococcal vaccine and enhancing immunological response. Population/Setting: A state-run Department of Corrections (DOC) clinic system serving just over 30,000 individuals was the site for this project. Incarcerated individuals present an increased risk of contracting pneumococcal disease due to close living quarters. Other risk factors such …

The Lived Experience Of Nurses In Caring For Patients With Covid-19, Jessica Barre

Electronic Theses and Dissertations

Limited research exists about the experiences of nurses’ caring for patients during the COVID-19 pandemic post hoc. To understand nurses’ realities of caring for patients with COVID-19, I aimed to understand the lived experience of nurses caring for patients with COVID-19 in the United States. A qualitative design with a hermeneutic phenomenological methodology was used. Sixteen participants were recruited via purposive sampling, augmented with snowball sampling. Data were collected through unstructured interviews and were analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Nurses’ experiences of caring for patients with COVID-19 in the U.S. were consolidated into four themes: “a living …

Effects Of Group Visits On Self-Care Management For Veterans With Type 2 Diabetes Mellitus, James Nwaizugbu

Doctoral Projects

Individuals diagnosed with type two diabetes mellitus (DM2) can be overwhelmed by daily choices, leading to self-care neglect. Self-care is vital to DM2 management to avoid chronic complications. This project utilized group visits to increase self-care management and improve outcomes among veterans with poorly controlled DM2.

This evidence-based practice (EBP) project used a single-group quasi-experimental pretest-posttest design to evaluate a self-care management program for US veterans with poorly controlled DM2 who were enrolled a clinic within the Department of Veterans Affairs (VA), Northern California Healthcare System (NCHCS). The study facilitator provided education on DM2, medication, diet, and exercise. Participants (N …

Primary Care Access In San Luis Obispo County- Primary Care Practitioner’S Perspectives, Jessica Peckham

Doctoral Projects

This study investigates healthcare access and utilization among Primary Care Providers (PCPs) in SLO County, utilizing a mixed-methods approach. Survey responses from PCPs when applied to Levesque’s Theoretical Framework reveal variations in provider approachability and acceptability, alongside significant wait times for both new and established patients, indicating barriers in healthcare reaching. Qualitative interviews further illuminated dimensions of healthcare access, including socioeconomic disparities and provider burnout. These underscore the complexities of ensuring equitable access to primary care services. The relationship between provider and consumer dimensions, such as work-life balance, workload, and the role of advanced practice providers, highlight the intricate dynamics …

A Multimodal Intervention To Aid In Smoking Cessation, Lauren Druzbicki

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC; 2023a) notes there are 28.3 million smokers in the United States. In Indiana alone, nearly 29% of adults currently use tobacco, with 19% of the total being cigarette smokers (Indiana Department of Health, 2022). The purpose of this evidence-based practice (EBP) project was to implement a multi-modal intervention to aid in smoking cessation in adults aged 18 and older who are cigarette smokers. The intervention included physician/nurse advise using the ask, advise, refer (AAR) model, the SmokefreeTXT program, and FDA approved smoking cessation medications. The project took place at a primary care …