Nursing Commons^™

Implementation Of Education And Use Of A Screening Tool To Assess Palliative Care Needs In The Critical Care Setting, Megan Stoeckinger

DNP Projects

Purpose: The purpose of this study was to measure palliative care knowledge, attitudes, perceived empowerment, and familiarity of the Supportive Palliative Care Indicators Tool (SPICT) among critical care nurses and advanced practice providers (APPs) before and after viewing a web-based educational video on an adult medicine intensive care unit (MICU).

Methods: This study was a one group pre- and post- implementation assessment using a web-based educational video and electronic surveys. The population included critical care nurses and advanced practice providers (APPs). This study spanned the timeframe between January 2022 and March 2022.

Results: Paired t-tests comparing pre-intervention …

Using The Samscore Questionnaire To Increase Skin Cancer Risk Screenings At Adult Patient Annual Exams, Taylor Abner

DNP Projects

Background: Malignant melanoma has become an increasingly prevalent problem in the United States. The earlier a skin cancer is identified, the better the outcome. There are conflicting recommendations about screening for skin cancer but in general identifying high risk patients is important and it is not being achieved in primary care.

Purpose: The purpose of this study is to evaluate use of the SAMScore Questionnaire to determine high risk patients at adult annual visits.

Methods: This was a multi-phased study with a quasi-experimental design that took take place at a family and community primary care clinic in central Kentucky. Baseline …

Screening For Severe Mental Illness In A Correctional Setting Using The Brief Jail Mental Health Screening Tool, Stephanie Kohl

DNP Projects

Abstract

BACKGROUND: Prisoners who are detained in jails and detention centers have higher rates of Severe Mental Illness (SMI) compared to the general population. However, SMI is often unidentified in this population, largely due to lack of assessment using effective SMI screening tools and lack of knowledge among prison staff about the prevalence of SMI and the importance of identification in the correctional setting. Prisoners with SMI often act out violently against others and themselves. Current standard practice for SMI screening varies significantly across jails. Many jails use standard medical questionnaires which help obtain a brief medical history but often …

Evaluating Colorectal Cancer Screening Rates In An Urban Primary Care Practice, Kristen Makowski

DNP Projects

Colorectal cancer accounts for 8% of all cancer deaths and can be prevented through timely removal of colon polyps. Despite recommendations for routine screening, approximately 31.2% of patients go unscreened for this disease (Centers for Disease Control and Prevention, 2018). The purpose of this project was to determine screening rates and documentation mechanisms for colorectal cancer in an urban primary care practice, to determine how many patients completed the screening, and to present findings to the practice providers along with exploring ways to increase screenings. An additional purpose of this project was to determine and identify patient demographics which can …

Improving Assessment, Documentation, And Ordering Of Diabetic Retinopathy Screenings In A Primary Care Clinic, Lauren N. Motto

DNP Projects

Abstract

BACKGROUND: Diabetes mellitus (DM) is the leading cause of new blindness in American adults. As the number of people with type 2 diabetes continues to increase, the total number of people affected by diabetic retinopathy (DR) will continue to rise. Improved access to screening for DR, followed by treatment, if necessary, can reduce the progression to vision loss. Despite national recommendations, less than half of Americans with DM complete annual diabetic retinopathy screenings (DRS).

PURPOSE: The purpose of this project was to improve assessment, education, documentation, and ordering of DRS for patients with a diagnosis of type 1 and/or …

Barriers To Screening For Intimate Partner Violence Among Aprns In Kentucky, Kathryn L. Strait

DNP Projects

Abstract

Purpose:Intimate partner violence (IPV) occurs in at least one in every four females and one in nine men across the United States (Smith et al., 2017). While the prevalence of IPV is considerably high, the screening rates for IPV in primary care specifically average less than 12% (United States Preventative Services Task Force, 2013). Methods: In order to identify how to overcome the barriers to screening including time, knowledge of IPV, access to community resources, gender identity/sexual orientation, accuracy and availability of screening tools, and reimbursement for advanced practice nurses in Kentucky, a survey was sent to …

Evaluation Of Depression Screening By Providers For Adult Patients With Type 2 Diabetes In Primary Care, Kristy M. Bryant

DNP Projects

BACKGROUND: Depression in adults with type 2 diabetes can lead to non-adherence to self-management behaviors and treatment recommendations, and ultimately worse health outcomes. Currently, only 50% of adult patients with type 2 diabetes treated in the primary care setting are screened for depression. Without screening for depression, a diagnosis of depression and subsequent treatment is likely to be missed and the patient is more likely to experience worse health outcomes and worse quality of life.

PURPOSE: The purpose of this study was to evaluate impact of provider education on improving screening rates for depression in adult patients with type 2 …

Gun Violence Screening In The Adolescent Setting, Amy Burnett

DNP Projects

Objective: The purpose of this project was to implement a routine gun violence screening tool into practice in order to assess the need for this type of screening in the Adolescent Medicine Clinic at the University of Kentucky.

Methods: This study used a quasi-experimental one group posttest design to examine the impact of the implementation of a gun violence screening tool on the proportion of patients screened and the proportion of patients referred for intervention that screen positive.

Results: There were 44 adolescent patients that participated in this study (n=44). Twelve out of 44 participants screened positive, which means they …

Screening For Alcohol Use, Misuse, Or Abuse In The Primary Care Setting Using The Audit-C Tool: An Extension Study, Courtney Amanda Minnis

DNP Projects

Abstract

PURPOSE: The purpose of this study was to improve alcohol screening rates in one primary care setting by educating and supporting providers and office staff on the use of the Audit-C alcohol screening tool.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected utilizing a retrospective chart review from the electronic medical records of adults over age 18 years by visit type: New Patient Visit, Annual Visit, or Employee Wellness Exam. Data included: demographic data of patient age, race, gender, the Audit-C score, and whether or not an intervention was performed.

RESULTS: Five providers …

Implementation Of The Stop Bang Screening Instrument For Obstructive Sleep Apnea Within The Intensive Care Unit And 5 East Cardiac Unit, Michael T. Lush

DNP Projects

BACKGROUND: Recent studies have found that OSA without the use of CPAP is an independent risk factor for cardiovascular disease and hypertension, which can lead to myocardial infarction (MI) and cerebral vascular accident (CVA) or stroke. This increases patient morbidity and mortality rates as well as medical costs. In those suffering from a myocardial infarction (MI) or cardiovascular accident (CVA), an important intervention is proper screening for the presence of OSA while in the acute care setting. The STOP BANG screening instrument is a simple yet effective tool in assessing for sleep apnea symptoms with a respective sensitivity of 93% …

Dyslipidemia Screening In Children Between The Ages Of 9 And 11 Years: An Evidence-Based Approach, Meredith Toms

DNP Projects

PURPOSE: The purpose of this study is to examine the outcome of healthcare provider education on the incidence of dyslipidemia screening in a pediatric primary care clinic.

METHODS: The design of this study was a descriptive pre and post design to evaluate if dyslipidemia screening rates, knowledge, and self-efficacy of healthcare providers changed following an education series at a general pediatric clinic in Lexington, KY. The rates of dyslipidemia screening were calculated prior to providing provider education as well as afterwards to see whether there was an improvement in screening rates. Provider’s knowledge and confidence before the education series was …

Evaluating The Effect Of A Nurse Navigator In Increasing Colorectal Screening, Christine Njogu

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a nurse navigator in increasing colorectal (CRC) screening in primary care setting.

METHODS: This was a descriptive retrospective study of the effect of nurse navigators in increasing colorectal screening in primary care settings within Jefferson county and its surrounding counties. The sample consisted of 200 patient chart reviews for the period of September 1st through December 31st, 2017. Rates of colorectal screening were compared in those who received a nurse navigator call and those who did not.

RESULTS: Overall screening rates were 44.6%. A distinct increase in screening …

Evaluation Of Depression Screening Implementation In The Adult Inpatient Heart Failure Population: A Process Outcomes Evaluation, Jennifer Sustek

DNP Projects

BACKGROUND: Extensive study has found depression in heart failure (HF) patients to be a significant risk factor which has been associated with poor outcomes and increased medical cost for this population. It is highly recommended to screen HF patients for depression to identify this important risk factor. The PHQ-9 depression screening instrument (sensitivity 70% specificity 92%) has been identified as a valid measure to detect depression in the HF population. Implementing a depression screening protocol in an inpatient environment requires education of providers to establish awareness of best practice and foster confidence in their application of the screening instrument. OBJECTIVE: …

Evaluation Of Depression Screening Practices In Comorbid Patients In The Primary Care Setting, Kristyn L. Clark

DNP Projects

SPECIFIC AIMS: To evaluate the current rates of depression screening using the PHQ-2/9 in patients with comorbid conditions at a single, urban primary care office; to explore barriers to depression screening among providers.

METHODS: A retrospective chart review was completed on a sample of 188 patients seen between January and June 2017. Patients were equally divided among four comorbid diagnoses- COPD, obesity, hypertension, and type 2 diabetes. A provider interview was conducted to identify depression screening barriers and typical treatments regimens.

RESULTS: A total of 70.2% of patients had a documented depression screening. Of 67 patients diagnosed with depression, 11.9% …

Getting The Most Out Of Pediatric Screenings, Carly R. Oliver

DNP Projects

Purpose: The purpose of this study was to compare the results of the Ages and Stages Questionnaire to the Survey of Well-Being of Young Children to determine if they produced the same outcomes. The Survey of Well-Being of Young Children offers additional screening tools that address risk factors for child abuse, that the Ages and Stages does not include. This project also surveyed the caregivers completing the questionnaires to determine which questionnaire they found more beneficial.

Background and Significance: In the United States, approximately 15% of children ages 3 to 17 years of age have at least one developmental disability. …

Compliance With The 2015 American Diabetes Association Screening Guidelines For Diabetes Mellitus Type 2 In Primary Care, Krista L. Johnson

DNP Projects

Purpose: The purpose of this project was to evaluate provider use of hemoglobin (HgA1c) measurement as a method of screening for Type Two Diabetes Mellitus (T2DM) per the 2015 American Diabetes Association screening guidelines in a multidisciplinary primary care clinic in Kentucky.

Methods: A retrospective electronic medical record review was conducted in a large ambulatory care clinic. A master list was compiled of all patients aged 45-89 years who were seen for any reason the first week of November 2015. A total of 127 records that met inclusion criteria were randomly selected. The proportion of patients who were appropriately screened …

Improving The Identification, Delivery Of Care, And Outcomes Of Hospital-Acquired Sepsis, Nicholas James Welker

DNP Projects

Sepsis syndromes that develop among a hospital inpatient population can be difficult to differentiate from other disease processes that share systemic inflammatory response syndromes. A bedside nurse-driven screening process was developed at Baptist Health Lexington to aid with early sepsis identification and foster prompt goal-directed therapy. This retrospective study of 26 patients identified over a 6 month period measures intensive care length of stay, mortality, and sepsis severity. Exclusion criteria were pregnancy and Do Not Resuscitate orders.

Screening compliance was poor at 23.1 percent (n=6). Complete compliance with goal directed therapy was 7.7 percent, though some components of therapy such …

Assessment Of Depression Screening In Women’S Primary Care Clinic, Susanna Gorton

DNP Projects

Purpose: The purpose of this practice inquiry project was to evaluate provider adherence to depression screening documentation in the ambulatory electronic health record (AEHR) before and after changing locations of the depression screening questions within the AEHR. Provider knowledge about depression screening and barriers related to depression screening were also examined.

Methods: A retrospective chart review was completed for patients seen for an annual exam by a physician provider in a women’s primary care clinic. Data collected included demographic data, co-morbid conditions, depression screen documentation (PHQ-2 & PHQ-9), and interventions documented. A questionnaire was sent to providers in the primary …

Documentation Of Smoking History And Adherence To The Uspstf Recommendation For Lung Cancer Screening: A Retrospective Chart Review, Laura A. Golden

DNP Projects

Purpose: The purpose of this project was to evaluate provider compliance with documentation of smoking history and, if criteria met, referral for lung cancer screening as recommended by the United States Preventive Services Task Force in 2013.

Methods: A retrospective chart review was conducted using an electronic medical record (EMR) at a large, rural community family practice clinic. Patients meeting inclusion criteria of having a smoking history (current or past) of 30 pack years, aged 55 to 80 years, and no history of lung cancer diagnosis were included for randomization. One hundred patients were selected from 300 randomized charts; five …

Retrospective Analysis Of Body Mass Index Screening And Obesity Counseling In A Primary Care Setting: Comparative Analysis Of Demographic Variables And Co-Morbidities, Christina Fisher Higdon

DNP Projects

Study Purpose: To assess obesity screening and counseling in patients at annual wellness exams in an urban primary care clinic. Specific aims of the study: determine percentage of patients with documented body mass index (BMI), ICD-9/ICD-10 diagnosis of overweight or obesity, documentation of education or a follow-up plan for weight management, follow-up visit for weight loss and documentation by provider, and comparative analysis of co-morbidities and demographic variables during well-exam visits.

Target Population and Measures: Adults over the age of 18 in an urban primary care clinic with a BMI greater than 25 kilograms (kg)/meters squared (m2). BMI screening and …

Evaluating Adherence To Colorectal Cancer Screening, Jaime Bradley-Miller

DNP Projects

Purpose: The purpose of this project and literature review was to determine provider documentation practices of colorectal cancer (CRC) screening, identify the percent of clinic patients who need to be screened, and develop a set of recommendations and targeted interventions which will increase CRC screening rates.

Methods: A retrospective chart review including males and females of all ethnicities between the ages of 45 and 80 was performed in one primary care practice. A randomized sample of 360 office visits between February and November of 2015 were selected, of which 281 met the inclusion and exclusion criteria. Patient demographics and characteristics …

An Evaluation Of Childhood Overweight And Obesity Screening And Management In The Primary Care Setting, Stephanie Horning

DNP Projects

Background-In Kentucky, 19.7% of children ages 6-11 years old are obese ("Center for Disease Control and Prevention (CDC)," 2013). Approximately 50% of these children will become obese adults (Lazarou & Kouta, 2010). It is imperative that interventions are initiated to normalize weight in childhood to offset the long term physical and psychosocial risks associated with obesity.

Purpose-The purpose of this gap analysis was to evaluate the screening and management of childhood overweight and obesity in one of Norton’s healthcare primary care setting.

Methods-The electronic medical records of 35 children aged 10 to 11, who had BMIs > 85 …

An Assessment Of Current Nicotine Screening Rates And Practices Within Primary Care, Kathryn A. Dunlap

DNP Projects

Purpose: The purpose of this project was to explore the current practices related to nicotine screening in the primary care setting within the Norton Healthcare System. The objectives were to assess: 1) the current compliance rate for nicotine screening and documentation per visit for patients who are seen in a primary care office, and 2) documentation of tobacco cessation counseling and pharmacologic management for patients seen in a primary care office.

Methods: A retrospective chart review was conducted to assess the current compliance rate for nicotine screening and documentation per visit for patients who are seen in a primary care …

Adolescent Risk Behaviors, Screening, And Referral At An Adolescent Health Clinic: A Retrospective Review, Cheryl Marrs

DNP Projects

Aim: Investigate provider patterns of risk behavior screening at an adolescent health clinic and describe findings from a study that investigated patterns of risk behavior screening in an adolescent health clinic.

Background: Adolescents who engage in risky behaviors are vulnerable to problems with current and future mental health issues such as depression, substance use, or other psychiatric disorders. Identifying the risky behaviors in adolescents that are associated with the potential presence of depressive symptoms can be helpful to the provider when deciding to refer an adolescent for further mental health assessment. Provider fidelity in risk behavior screening is central to …

Dnp Practice Inquiry Project Report: Depression Screening In Primary Care, Mary Kathleen Stafford

DNP Projects

Depression affects many people worldwide and is a leading cause of disability. National guidelines and recommendations have been created that support screening for depression in the primary care setting, however due to many barriers depression screening is often not performed or documented. This capstone project consists of three manuscripts, which evaluate the lack of depression screening in the primary care setting. The first manuscript is an integrative review of the literature to support depression screening in primary care and to address barriers to depression screening. The second manuscript is a guideline analysis of a national guideline published by the Institute …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Screening For Sepsis: A Key Strategy For Early Identification And Management Of Septic Patients, Amy P. Fisher

DNP Projects

Background: Sepsis, defined as a systemic inflammatory response to infection, is a life-threatening medical condition that rapidly progresses from severe sepsis (characterized by signs of organ dysfunction) to septic shock with fluid-refractory hypotension. Adherence to the Surviving Sepsis Campaign guidelines for the management of severe sepsis and septic shock have been associated with improved delivery of care and reduced mortality. Delays in recognition of sepsis has been identified as a barrier to achieving early goal-directed therapy targets.

Purpose: To determine if a sepsis screening protocol could facilitate earlier identification of patients with sepsis

Methods: A retrospective medical record review was …

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …