Nursing Commons^™

Establishing A Structured Mentorship Program For Novice Advanced Practice Registered Nurses In The Veterans Health Care System, Rodney Duckett

Doctor of Nursing Practice

Background. Mentorship is an age-old strategy still widely sought after to increase integration into the workforce. Employers of new APRNs must be aware that newly graduated APRNs are inexperienced. To maximize the employers’ investment, training on proper integration should be a high priority. This Doctor of Nursing Practice (DNP) project addressed this quality improvement issue through the implementation of a structured mentorship program to improve the overall transitioning of newly hired APRNs in the Veterans Health Care System (VHCS). Problem. The VHCS lacks a formalized, structured mentorship program for newly graduated APRNs entering the VA System. Intervention. Seven APRN mentors …

Assessing Nurse Practitioners' Knowledge And Clinical Practice With Regard To The Oral-Systemic Link, Angela Haynes

Electronic Theses and Dissertations

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall …

Optimizing Peripheral Neuropathy Management Through Vitamin B12 Screening In Adults With Type Two Diabetes Mellitus Taking Metformin, Jonathan Sidle

Doctor of Nursing Practice

Peripheral neuropathy is a significant co-morbidity for patients with diabetes and as early as 1969, metformin was linked to reductions in vitamin B12, leading to deficiency. Vitamin B12 deficiency causes increased levels of homocysteine and methylmalonyl-CoA which are toxic to the nervous system and therefore can contribute to demyelination. This quality improvement study aimed to optimize the management of peripheral neuropathy symptoms by implementing a process to identify patients with clinical or subclinical vitamin B12 deficiency and initiating replacement therapy. Adult patients presenting for a scheduled office visit with a diagnosis of type two diabetes and are taking metformin or …

Implementation Of An Electronic Alert For Improving Adherence To Diabetic Foot Exam Screenings In Type 2 Diabetic Patients In Primary Care Clinics, Ruby Denson

Student Scholarly Projects

Practice Problem: Patients with type 2 diabetes mellitus (T2DM) are at an increased risk of complications including foot ulcerations (Harris-Hayes et al., 2020). Preventive care is essential for the early detection of foot ulcers but despite the advantages of preventive screening, a limited number of primary care providers perform annual foot exams (Williams et al., 2018).

PICOT: The clinical question that guided this project was, “In adult patients with T2DM receiving care in a primary care setting, will the implementation of an electronic clinical reminder alert (ECR) increase provider adherence to performing an annual diabetic foot exam and risk …

Utilization Of Asthma Guidelines In Primary Care, Kate R. Miller

Dissertations

Background: Chronic lower respiratory disease, including asthma, is the fourth leading cause of death in the U.S. Financially, asthma accounts for approximately 54 billion dollars in healthcare spending annually. The National Heart Lung and Blood Institute [NHLBI] established guidelines to reduce impairment and to reduce future asthma attacks.

Purpose: This Quality Improvement (QI) pilot implemented the Asthma Control Test (ACT) and the Asthma Action Plan (AAP) per NHLBI guidelines. This project aimed to increase provider use of the ACT and AAP to 50% in patients with a diagnosis of asthma over one month.

Methods: A convenience sample of six adult …

Effect Of An Intervention To Improve Smoking Cessation Treatment In A Federally Qualified Healthcare Clinic, Shirley A. Camp

The Corinthian

Abstract

Significant progress has been made in the reduction of tobacco use in the United States, but the smoking prevalence among the socially and economically disadvantaged populations (i.e. individuals who are homeless, uninsured, LGBT, and living with HIV) is significantly higher than the general population (CDC, 2018b). As a result, these vulnerable populations carry a disproportionate burden of tobacco-related mortality and morbidity (CDC, 2018b). There is a cost-effective and evidence-based treatment for tobacco use dependence (Fiore et al, 2008), but the delivery by primary care providers to this population is inconsistent (Tyman, Bonevski, Paul, & Bryant, 2014). This study focused …

Implementing Trauma-Informed Care Early In The Lives Of Children And Adults, Carley Clymer

Scholars Week

Throughout the health care industry, providers are failing to recognize the implications that adverse childhood experiences (ACEs) have upon adult health. As a result, these patients not only have to endure these traumas, but they’re also faced with crippling health conditions that accompany them including depression, heart disease and obesity. The prevalence of common high-risk behaviors such as smoking, drinking and illicit drug use can also co-exist with adversity, which leads to an exacerbation of already poor health. This presentation aims to relay the significance of adopting a trauma informed care (TIC) approach early in the lives of clients to …

Implementing Mandatory Psychiatric Training For Medical-Surgical Nurses, Hannah Berry

Scholars Week

Hospitals worldwide experience poor outcomes for patients with mental illnesses. Psychiatric patients have a lesser likelihood of surviving a particular illness than does a person with that same illness who does not have a psychiatric comorbidity. This is a bleak reality that nurses have the unique opportunity to influence for the better. Destigmatizing mental illness is perhaps the largest component of stepping toward this goal. Our nurses being more educated on the nature of mental illnesses—their signs, symptoms, and common treatments—will improve care outcomes for patients who suffer from them. Not only should we educate nurses on mental illness for …

Brown Bag Review For Identification Of Discrepancies In Patient Medication Use, Chandra James, Shawna Mason, Shellye Vardaman, Amy Yoder Spurlock

Journal of Interprofessional Practice and Collaboration

Patients suffer unintentional harm from their medications. Many organizations have proposed that healthcare providers implement strategies to decrease medication related harm for patients. This study implemented a brown bag review along with medication safety education within a clinic that caters to the poor and uninsured. It was notable that the majority of the participants educational levels were equivalent to a high school graduate or beyond. In the pre-intervention survey, they expressed that they were knowledgeable about the purpose of their medicines, they knew the correct way to use their medications, and they were aware of potential side effects. During their …

Empowering Nurses Of Minority In The Face Of Incivility And Bullying: Through The Lens Of Phenomenology, Corrine Floyd

Dissertations

Abstract

Up to 85% of nurses have reported exposure to incivility in the workplace (Hunt & Marini, 2012). The often-subtle nature of incivility toward nurses in a minority population may partially explain why it remains a problem. Healthcare organizations realize the need for civility to counter the high turnover rate, staff shortages, and low job satisfaction reported by nurses, but lack understanding of how nurses of a minority population perceive incivility and bullying. This study aimed to answer the research question how do nurses with minority representation experience incivility and bullying versus empowerment in the workplace? A descriptive phenomenological design …

Contraceptive Methods In The United States: The Question Of Abortive Mechanisms, Tara Ferenczy

Senior Honors Theses

This thesis reviews the many methods of contraception available in the United States. Although society’s understanding of women’s health has become a major topic, there is still a significant deficit of information regarding how the accessible methods affect women’s bodies, specifically reproductive tissue. The thesis analyzes numerous contraceptive options focusing specifically on the mechanisms of action to determine whether options have abortifacient properties so that readers may develop educated opinions regarding medical and ethical uses. Information involving strengths and limitations of each technique and the effects on both the female body and the reproductive material assist in understanding the process …

Promoting Recognition And Rescue: Human Trafficking Screening, Erin E. Pittman

MSN Capstone Projects

The exploitation of human beings is a serious public health concern (Centers for Disease Control [CDC] 2018). The United States Department of Justice (2018) defines human trafficking as an act of coercing a person’s labor services or commercial sex acts. Family Nurse Practitioners play a significant role in the identification of victims, especially those practicing in emergency departments. A majority of healthcare providers have yet to establish a standardized screening tool and there is little evidence regarding the impact these screening tools have in recognizing victims of human trafficking (Emergency Nurses Association, 2018). This alarming information brings about the clinical …

Decreasing Bias And Improving Education On Non-Invasive Colorectal Screening Methods, Sara H. Hughes

MSN Capstone Projects

It is estimated that in 2020, nearly 148,000 Americans will be diagnosed with colorectal cancer and 53,200 Americans will die from colorectal cancer (Siegel et al., 2020). One- half of all cases and deaths are due to modifiable risk factors such as diet and smoking and it has been shown that early screening and detection can greatly decrease the morbidity and mortality of colorectal cancer yet colorectal cancer related deaths still ranks among the leading causes of cancer-related deaths in the United States and the world. Early detection of colorectal cancer is crucial to reducing mortality and although this is …

Patient Controlled Fluid Restriction Monitoring, Christina Tindel

MSN Capstone Projects

Patients are often placed under non-pharmacologic orders such as fluid restrictions during their hospital stay. The following article will discuss a plan to implement a change to have patients take a more active role in their plan of care by being the main ones to monitor their fluid intake.

Pcos Lifestyle Management Change Project, Elizabeth King

MSN Capstone Projects

This paper proposes the Lifestyle Modification Change Project to help fulfill this lack of education and emphasis on lifestyle modifications that occurs with patients diagnosed with PCOS. This change project would include a 16-week lifestyle modification program that would evaluate pre- and post- participation data including: BMI, weight, inches, testosterone levels, menstrual cycle regularity numbers, and quality of life questionnaire.

Aging: The Impact Of Diet And Inflammation, Morgan Wiland-Gress

Nursing Student Class Projects (Formerly MSN)

The immune system is a complex cohesive network. It requires every cell to work efficiently at maintaining homeostasis. It also prevents and repairs damage from internal and external pathogens. Recent research has focused on the concept of inflammaging, which is defined as age-related changes that occur in the immune system leading to dysfunction. The current understanding is that inflammaging contributes to the development of chronic diseases including; Type II Diabetes, Cardiovascular disease, Cancer, autoimmune disorders, neurological disorders, Alzheimer and Parkinson’s disease. The underlying pathophysiology of inflammaging is chronic inflammation and the imbalance of pro-inflammatory and anti-inflammatory mediators. This imbalance leads …

Self-Management And Quality Of Life In Young Adults After Healthcare Transition, Jennifer Herbert

Grace Peterson Nursing Research Colloquium

The transition from pediatric to adult healthcare has become healthcare concern of increasing importance as more adolescents with chronic conditions survive to adulthood requiring continuing care. In order to understand the current status of healthcare transition (HCT), we identified the HCT services received by young adults, their existing healthcare self-management skills and how skills correlated with their quality of life. A correlational and retrospective cross-sectional online survey of English-speaking young adults in the United States ages 18-26 with at least one pediatrically diagnosed chronic condition was conducted August-October 2019. Participants completed a healthcare transition feedback survey, the TRANSITION-Q self-management skills …

Improving Care For Homeless Young Adults: A Shelter Client And Health Service Provider Perspective, Kenya Kawanee Hemingway

Grace Peterson Nursing Research Colloquium

The purpose of this study was to determine if the healthcare needs of homeless young adults from the client, shelter staff, and shelter healthcare provider’s perspectives. Data was collected via focus group with homeless unaccompanied young adults (n=4), and an online survey with shelter staff and healthcare staff (n=8) of The Night Ministry (TNM) and Ignite Promise. The focus group was recorded, transcribed, and coded for themes. Inductive analysis revealed themes focused on improving the quality of services provided. Based on the findings, recommendations include assessing the needs of homeless unaccompanied young adults from their perspective utilizing larger sample sizes, …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Solutions To Address Frequent Hospital Attendance, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

In this editorial, practical solutions and considerations in helping the most complex and at-risk patients in our health systems are discussed. These patients, sometimes referred to as health care “super-utilizers” in the literature, tend to be frequently seen and cared for in costly hospital and emergency department settings. Innovative care models that aim to bridge system gaps, achieve better health outcomes, and improve the well-being of both patients and providers are needed and should continue to be explored.

Bridging The Gap In Primary Care Of Inflammatory Bowel Disease (Ibd) Patients, Deanna Dial

Dissertations

Abstract

Problem. Patients in rural or medically underserved areas (MUAs) with inflammatory bowel disease (IBD) have limited access to primary care preventative services, making them even less likely to obtain preventative care, placing them at even greater risk for adverse health outcomes.

Methods. A two-phase retrospective chart review utilizing a convenience sample of patients diagnosed with IBD from a privately-owned gastroenterology office to evaluate the effectiveness of increasing preventative screenings for IBD patients. The first review included 53 patients seen from January to April 2019. A preventative screening

evaluation tool (PSET) was developed based on literature recommendations, including the American …

The Effects Of High Dose Intravenous Vitamin C In Cancer Patients, Bankole Aluko

Dissertations

Problem: Currently used standard treatments (Chemotherapy, radiation) in cancer patients are generally accompanied with side effects, which may include pain, nausea, vomiting, fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) during and after completion of treatments. High dose IV C may improve the anti-cancer action of chemotherapeutic agents by reducing side effects of fatigue, pain, nausea and vomiting and boosting immune cell functioning, and inhibiting angiogenesis (Mikirova, Casciari, & Hunninghake, 2019).The purpose of this quality improvement project was to explore whether high dose intravenous vitamin C (IV C) prevented major side effects that frequently occur with standard treatments in cancer patients and …

Evaluation Of A Type 2 Diabetes Mellitus Care Coordination Program, Carrie Smith

Dissertations

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators …

Coronavirus, Carla Bonczak

Nursing Student Class Projects (Formerly MSN)

Coronavirus (COVID-19) is a novel virus that began its virulent spread in China December 2019. Since that time, it has spread worldwide and has affected individuals, business, and educational systems, as well as day to day life. COVID-19 has become a national pandemic. COVID-19 is spread through airborne droplets produced by affected individual that may or may not be symptomatic. Individuals may experience fevers, dry cough, and difficulty breathing. While most individuals with COVID-19 may be able to recover at home, several are requiring hospitalization. If patients are hospitalized, they are placed into an isolation negative air flow room for …

Evaluation Of Pharmacist- Or Nurse-Driven Long-Acting Insulin Titration Protocol In Adult Primary Care Patients With Type 2 Diabetes, Ruth Manzi, Corinn Martineau, Carmine Laporta, Mary Muca, Samantha Marrier, Donald Medd, Jennifer Aronson

Journal of Maine Medical Center

INTRODUCTION

Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.

METHODS

This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was …

Wound Healing, Emily Schmitter

Nursing Student Class Projects (Formerly MSN)

The topic being presented is wound healing. Wound healing is a pathological process that occurs in three phases: inflammation, proliferation and new tissue formation, and remodeling and maturation. Several factors can affect wound healing such as nutrition status, increased age and health status. Wound healing is relevant to advanced practiced nursing because APNs participate in prevention, assessment, and treatment of wounds. The APN is responsible for teaching diabetic patients about the importance of proper nutrition. The APN must also be able to identify a hard-to-heal wound. And the APN must know how to prevent infection and induce healing in hard-to-heal …

Healthcare Inequities Of The Hiv Population, Michael Silvka

Nursing Student Class Projects (Formerly MSN)

AbstractThe social attitude in the United States toward people living with HIV (PLWH,) has changed verylittle since the diagnosis became prevalent in the 1980’s. Healthcare inequities experienced by(PLWH) affect their well-being in many ways every day. The ability of society to decrease theseinequities is within our grasp. (PLWH) are depending on social determinants being addressedto allow equitable access to preventative measures, testing, and treatment of their illness. Theneed for appropriate and sustainable change to social perception of the HIV epidemic must beaddressed to ensure fair and equitable treatment is available to all persons affected by thisdisease

Sepsis Screening Education, Brittany R. Horn

Doctor of Nursing Practice Scholarly Project

Sepsis is a significant burden to the healthcare field with 1.7 million Americans annually diagnosed with this condition. Earlier diagnosis and treatment are the most effective ways of reducing morbidity and mortality related to sepsis. The current sepsis screening tool in place at Stormont-Vail Hospital, in Topeka, Kansas, is the systemic inflammatory response (SIRS) criteria; however, this screening tool has proven to be less effective than other screening tools available. The screening tools proven more effective than the SIRS criteria, are the quick sequential organ failure assessment (qSOFA) and the sequential organ failure assessment (SOFA). For this project, nursing staff …

Medical Noncompliance In A Pediatric Patient Living In A Single-Parent Household, Lucy Obianuju Norrell

Electronic Theses and Dissertations

Abstract Noncompliance is a patient’s inability to comply with the recommended treatment for their complete recovery from an ailment, while compliance is the extent to which a patient adheres to the provider’s directive, such as medication and orders given. The purpose of this study was to determine if motivational interviewing when applied to noncompliant pediatric patients from single-parent households, would improve global medical compliance in this population as compared to the standard of care at the end of three months. Thirty-two participants were recruited using the homogeneous purposeful sampling. The project employed a mixed-method approach. Fred Kleinsinger’s noncompliant behavior tool …

Barriers To Colorectal Cancer Screening In Adults: An Integrative Review, Julie Sanger

Nursing Masters Papers

Colorectal Cancer (CRC) is the third leading cause of death among American men and women. Colorectal cancer is a preventable cancer, with CRC screening recommended from the age of 50. The percentage of people who complete the recommended CRC screening is low. Individuals throughout the United States (US) are rarely offered the opportunity to discuss screening options with their provider and may never complete CRC screening due to multiple barriers. The purpose of this scholarly integrative review is to explore the reasons individuals are not completing CRC screening, including those related to different US populations, and discuss interventions that can …