Nursing Commons^™

Implementation Of The Diet Readiness Test To Assess Self-Efficacy And Education Effectiveness In Overweight Women, Tatjana Ilich

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based Doctor of Nursing Practice (DNP) project was to assess perceived self-efficacy in overweight women who are participating in a weight loss program and the effectiveness of education being provided using the Diet Readiness Test (DRT).

Background: Obesity is a rapidly growing public health problem affecting an increasing number of countries worldwide because of its prevalence, costs, and health effects. Among women between the ages of 40 and 60, more than 80% report that they are either trying to lose weight or trying to maintain weight. The overall prevalence of obesity was similar among men …

Anxiety And Agitation In Adult Patients Admitted To An Emergency Room During The Covid-19 Pandemic, Doris L. Asombrado

Dissertations

Purpose: The purpose of this retrospective correlational study was to identify the relationship between COVID-19 status and the prevalence of anxiety-agitation with select sociodemographic and clinical characteristics in adults admitted to the ED during the pandemic (03/01/2020 through 12/31/2020).

Background: COVID-19 infections combined with the WHO and CDC recommendations to mitigate spread have had deleterious psychosocial and economic outcomes with the risk of subsequent COVID-19 related mental illness. Studies indicate one in three adults experience anxiety or depression.

Methods: This retrospective correlational study reviewed 2,572 psychiatric admissions from a Southern California ED during the pandemic from March 1, 2020 through …

Implementing Outpatient Screening Of Adult Patients At High Risk For Peripheral Artery Disease, Coral Roseberry

Doctor of Nursing Practice Final Manuscripts

Background: Peripheral artery disease (PAD) is a prevalent chronic vascular disease that remains often underdiagnosed and inadequately treated. The development of PAD increases both with age and with the presence of modifiable and non-modifiable risk factors. Risk factors for PAD include smoking, diabetes, hypertension, hyperlipidemia, and chronic kidney disease. Furthermore, PAD can be an indicator of systemic atherosclerosis which is associated with coronary artery disease, carotid stenosis, and cerebrovascular disease. Undiagnosed obstructive PAD contributes to damaging atherosclerotic sequelae such as claudication, ulcers, infections, peripheral neuropathy, and amputations. It is common for PAD to exist in the absence of symptoms; therefore, …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

The Impact Of Personal Barriers To Incorporating The American Heart Association Diet, Aaron Bigando

Doctor of Nursing Practice Scholarly Project

The leading cause of death worldwide is cardiovascular disease. Diet is the most influential, modifiable factor related to the development and progression of cardiovascular disease. The American Heart Association developed a diet that delivers guidelines for diet. Therefore, identifying the most significant factors that hinder the effectiveness of the diet was necessary. These hindrances can be categorized as physical, psychosocial, and socioeconomic barriers. Demographic differences also impact diet.

A survey was developed to identify and account for the most common dietary barriers. The Barriers to Healthy Eating scale addressed different circumstances which impact diet. By using this scale, providers can …

Fantastic Four, Jaden Zumbahlen, Andrea Palmer

Doctor of Nursing Practice Projects

Clinical Issue
Heart failure claims one in four lives of those diagnosed each year. The term Guideline Directed Medication Therapy (GDMT) represents optimal medication therapy as defined by the American College of Cardiology Foundation and American Heart Association. Appropriate quadruple therapy results in an estimated 73% relative reduction in mortality over a two-year time span (Greene & Khan, 2021). However, there is a gap in proper GDMT stemming from suboptimal initiation and/or titration in the outpatient setting.

Project Implementation
Nursing staff in a rural midwestern cardiology clinic were provided with an in-service presentation discussing current guidelines and recommendations of GDMT …

Use Of Anticipatory Guidelines In Late Infants And Toddlers 12 To 24 Months In Primary Care, Claire E. Eller

Doctor of Nursing Practice Projects

Anticipatory guidance is a well-known and utilized method that has been implemented in a majority of pediatric primary care offices. As the need for efficiency grows and increasing patient volumes climb, there is a growing need for strategies to provide this information effectively and efficiently. Prior evidence can be utilized to identify the most critical knowledge caregivers and parents will require. Our findings indicate safety, communication, nutrition, social development, and behavior as cornerstone topics for anticipatory guidance. To increase the volume of education provided to parents and caregivers, alternate methods beyond verbal discussion could be used. After gathering scientific literature …

Caring For The Adult Patient With Autism: Development Of Staff Education And An Online Toolkit For Healthcare Providers, Kristen Conkle

Doctor of Nursing Practice Projects

There are disparities in knowledge among healthcare workers when caring for adult patients with autism spectrum disorder (ASD). Lack of knowledge about the characteristics of this population and strategies to enhance care pose a barrier to treatment during hospitalization. A computer based educational module was developed and assigned to staff at a community hospital. An online toolkit for healthcare providers was developed to aid staff in recognition of triggers and supplied adjunct methods for communication. A pre and posttest of healthcare provider knowledge and stigma regarding autism was performed. Achievement of the training was robust among staff; of the one …

Sti Education For Adolescents, Maryann Van Ryn, Lucy Nyrongo

Doctor of Nursing Practice Projects

Adolescents make up the majority of STI cases in the United States; however, most STI education has not targeted them and their unique needs. This quality improvement project aimed to create an evidence-based educational tool for sexually transmitted diseases (STIs) for adolescents in a pediatric clinic. Next, we created a dynamic QR code to access the flyer digitally on a patient's mobile device. The QR code was printed and placed in an accessible location in the office. The dynamic QR code allowed us to capture data on the total number of scans and provided the demographics of the scanners and …

Increasing Education And Awareness Of Patients Who Identify As Transgender In Primary Care​, Cindy Wallace

Doctor of Nursing Practice Projects

Background. Lesbian, gay, bisexual, and individuals who identify as transgender and queer (LGBTQ) often experience negative healthcare encounters (Parameshwaran et al., 2017). According to the Williams Institute of Law (2022), there are 1.3 million adults who self-identify as transgender. This education project utilized a pre/post-test design to explore attitudes, practices, and knowledge of primary care providers when interfacing with individuals who identify as transgender in primary health care settings.

Theoretical Framework. This project was guided by Lewin’s Change Theory.

Methods. Primary care providers in an urban community health clinic received a pre and post-education survey. A teaching session was delivered …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Improving Health Prevention Screening In A Rural Health Clinic, Shawn M. Mcnally

Masters Projects

Background: Health prevention screening has recently been highlighted in many initiatives from leading countries around the world. Breast cancer screening, cervical cancer screening and osteoporosis screenings are among the highest objectives for many of these initiatives as national health agencies focus on reducing morbidity and mortality by early detection.

Local problem: Baseline quality metrics reported for one clinic show the appropriate ordering of these health screenings is below the national benchmarks and the organizational benchmarks.

Methods: The project was designed as a quality improvement project based in a critical access region serving a rural population.

Interventions: The project intervention …

A Multimodal Smartphone Application Intervention To Achieve Target Weight Goals In Overweight Adult Diabetics, Michael Thomas Schwuchow

Evidence-Based Practice Project Reports

Obesity is the leading risk factor for developing type 2 diabetes mellitus (American Diabetes Association, 2022). Diabetes mellitus (DM) and obesity put individuals at higher risk for developing heart disease, stroke, and hypertension, therefore, it is essential to properly manage both conditions. The purpose of this project is to determine if the implementation of an evidence-based weight loss intervention, MyFitnessPal© will result in reduction in body mass index (BMI) and lower hemoglobin A1c (HbA1c) levels in overweight adults with DM. A comprehensive literature search of six databases, hand searching, and citation chasing yielded 13 pieces of moderate to high quality …

The Effect Of Implementing Behavioral Counseling For Elevated Ldl Levels, Blake L. Hansen

Evidence-Based Practice Project Reports

Hyperlipidemia is a key risk factor in cardiovascular mortality, and is prevalent in approximately 38% of American adults (CDC, 2022b). Cholesterol levels are intensified by unhealthy lifestyle choices, which means a change in lifestyle behaviors could prevent cardiovascular related deaths (WHO, 2022). The PICOT question for this project was: In adults aged 20 years or older in the primary care setting who have elevated low-density lipoprotein (LDL) levels (P), does the implementation of behavioral counseling on lifestyle modifications (I) compared to current practice (C) decrease LDL levels (O) over a 10- to 12- week period (T)? Fourteen participants from a …

Implementation Of A Comprehensive Diabetic Foot Care Program In Primary Care, Peguy Sylvain

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Diabetes Mellitus is a growing health problem in America. Uncontrolled diabetes can result in vascularcomplications. One of the most common complications of diabetes is diabetic peripheral neuropathy. Early foot carescreening can help prevent Diabetic peripheral neuropathy and other complications such as skin injuries, burns, falls,infection, lower- extremity amputations, and peripheral arterial disease. Interventions that have been shown to improve theidentification of diabetes foot complications include staff education, screening and assessment, use of monofilament,tuning fork for diabetic foot assessment, patient education/ self-care, standardization, and use of electronic medical records(EMR)/electronic reminders.

METHODS: The Plan Do Study Act method of quality improvement …

Introduction Of Hiv Point-Of-Care Testing In Adolescent Primary Care: A Quality Improvement Project, Jennifer Quinn Belfry

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: HIV, first identified in 1981, remains a persistent public health problem affecting 1.1 million Americans today. Detection is a critical first step to ending the HIV epidemic and the CDC recommends universal HIV screening for all patients 13-64 years of age regardless of risk factors. HIV screening rates are suboptimal especially in adolescent and young adult populations who face unique barriers to screening. The aim of this project was to improve HIV screening rates in adolescent and young adult patients at a large, urban FQHC.

LOCAL PROBLEM: In the state of Rhode Island, 1 in 10 persons living with …

University Campus Breastfeeding, Knowledge, And Perceptions Of Support: An Exploratory Study, Allison L. Scott, Ann W. Lambert, Chih-Hsuan Wang, Kelly V. Johnson, Jessica Weiss, Tony Stankus

The Eleanor Mann School of Nursing Faculty Publications and Presentations

Breastfeeding is often considered principally a biological issue but success is impacted by the socio-ecological environment of the lactating parent. Identifying current attitudes towards breastfeeding is essential in the effort toward normalizing breastfeeding in communities, including university campuses. The study explored campus community knowledge, awareness, and attitudes about breastfeeding, including available resources and applicable laws on two university campuses in the southern United States. This cross-sectional, self-reporting study utilized the Iowa Infant Feeding Attitude Scale and an adaptation of the Breastfeeding Behavior Questionnaire to survey a convenience sample. Results revealed decreased awareness of protective laws, availability of private lactation space, …

Evaluating Implementation Of Diabetes Screening In Family Practice, Makilah Furlan

Masters Theses/Capstone Projects

Poster presentation on implementing diabetes screening in family medicine practice.

Personal Health Questionnaire-9 And Interventions In Adults, Grace Alford

Masters Theses/Capstone Projects

This is an evaluation of the PHQ-9 depression screening and interventions in adults within an urban setting.

Tiny Tusk Internship: Barriers To Effective Breastfeeding Within Low Socioeconomic Populations, Catherine Johnson

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Tiny Tusk Breastfeeding and Infant Support is a program created to facilitate safe and quiet places for mothers to breastfeed at various events at the University of Arkansas. It serves as a platform to spread important and essential information about breastfeeding to mothers and reach various women all from different backgrounds and populations. The purpose of this review of literature is to identify barriers that women within low socioeconomic populations face that influence their decision to breastfeed. These barriers included lack of social support from family, friends, and healthcare providers; latch difficulty; and concerns of milk supply. Altogether, low-income women …

Infertility: An Evaluation Of Treatment Modalities And Ethical Considerations, Elise Ferenczy

Senior Honors Theses

This thesis reviews a variety of options for treatment of infertility, along with ethical considerations for each. The basis for ethical concerns will be primarily a biblical worldview, as the goal is to support Christian couples in decisions regarding infertility treatment. The biblical worldview is outlined to provide readers with an understanding of its core principles, and the Bible is used as the primary source for ethical discussion. The most common etiologies of infertility are outlined, followed by treatment modalities grouped by category. While some modalities present very few ethical concerns, others require careful consideration in many regards. Many of …

Examining The Effectiveness Of Physical Activity Patient Education In Improving Hba1c, Nadieh Samiaei

Doctoral Projects

Regular physical activity plays an important role in maintaining good health and managing and reducing HbA1c among type 2 diabetes patients. The goal of this study is to examine the effectiveness of physical activity in reducing the HbA1c among the type 2 diabetes patients of a local community health center in San Leandro, California. A quasi-experimental, pretest-posttest single site design project was conducted among a sample of 24 patients who had type 2 diabetes. The participants were selected to attend regular patient education classes promoting physical activity, diet, and lifestyle change as a measure of controlling diabetes. A paired sample …

Prevention Of Obesity-Related Morbidity & Mortality In Adults, Rachelle Virgin

Masters Theses/Capstone Projects

Poster presentation on the prevention of obesity related morbidity and mortality in adults.

Understanding The Experiences Lived By Nurses Caring For Patients With Covid-19: A Hermeneutic Approach, Awatif Mansoor Alrasheeday, Ma. Venus Borja, Eddieson Pasay-An, Farhan Alshammari

Makara Journal of Health Research

Background: Nursing is highlighted among professions that value caring and is perceived as the profession’s heart and soul because of its critical role in providing and delivering high-quality patient care, especially during this coronavirus disease 2019 (COVID-19) pandemic. However, little is understood about the experiences of the frontline workers in caring for persons diagnosed with COVID-19. This study aimed to explore the experiences of nurses in caring for persons diagnosed with COVID-19 inspired by the four lived worlds of van Manen.

Methods: The hermeneutic phenomenology was used in nine nurses working in hospitals of Hail region. This study …

Brining Point-Of-Care Ultrasound To A Rural Primary Care Clinic, Caleb E. Migda

Masters Projects

Background and Objectives: In the rural primary care setting, the process for outpatient

ultrasound testing has multiple steps, all of which provide opportunities for delay in testing and diagnosis. Point-of-care ultrasound (POCUS) is a solution that allows the physician to perform same-day ultrasound in the primary care clinic. The objective of this program development project was to implement POCUS in a rural primary care clinic to reduce time to testing and diagnosis for those patients requiring ultrasound testing.

Methods: A 3-month chart audit was conducted to examine the average length of time required to complete ultrasound testing in the outpatient …

Type 2 Diabetes Nutrition: A Video-Based Education Approach, Erin Russell

Masters Projects

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease associated with life- threatening outcomes. To prevent such outcomes, people with diabetes must possess the knowledge and skills required to manage their chronic disease. Objectives: To evaluate the impact of video-based education (VBE) on participant Diabetes Self-Management Education Skills (DSMES). Methods: The experimental study was conducted in a primary care office in a Midwest state. A convenience sample of 55 participants was selected. Pre- and post-implementation surveys were administered to measure change in self-efficacy between DMSES scores after viewing the VBE intervention. The Wilcoxon Rank Sum test was performed using …

Improving Adherence To Annual Retinal Screening Among Adult Diabetics In Rural Midwest, Sarah Hunger

Doctoral Dissertations & Projects

Background: Diabetic retinopathy (DR) affects millions of people worldwide and is a main cause of preventable blindness. Experts recommend annual retinal screenings on all diabetic patients. Studies show continuing trends of non-adherence, as well as significant barriers to screenings. Recommendations to overcome barriers and methods to improve adherence among diabetics are topics of interest among healthcare providers. The purpose of this project was to increase annual retinal screening adherence among adult diabetics at a privately owned primary care practice in the rural Midwest.

Methods: Staff and 59 patients, chosen through convenience sampling were involved. Pre- and post- implementation surveys were …

Revising The Team Huddle Process In A Federally Qualified Health Center, Donna Demann

Masters Projects

Abstract Background: Interdisciplinary team collaboration is a component of the patient centered medical home (PCMH) and can be met by completion of a daily team huddle (DTH). Local Problem: A federally qualified health center (FQHC) requested help revising the team huddle process to make it more beneficial for staff and patients. Goal was to improve team cohesion, collaboration, and communication and ultimately improve patient outcomes. Methods: The problem was addressed through revision of the huddle process. Process changes were guided using the actions from an evidence-based huddle framework and implementing additional teamwork strategies. Interventions: This project reconstructed the current huddle …