Empowering Newly Diagnosed Patients With Hypertension In Reducing Complications Through Self-Managed Care, Ana Pacis

Doctor of Nursing Practice Final Manuscripts

Background: High blood pressure affects millions of people, including children and adults. According to the Centers for Disease Control and Prevention (CDC), about 1 in every 3 adults or approximately 75 million American adults are affected with high blood pressure. High blood pressure often does not cause any signs and symptoms, which is why it is also known as the “silent killer,” and many people are not aware that they have elevated blood pressure (AHA, 2017). If high blood pressure is not controlled, it can lead to other heart diseases such as stroke. It can also cause other health problems, …

The Supplemental Impact Of Telephone-Based Lifestyle Modification Counseling In An Outpatient Weight Loss Clinic, Leslie Rangel Gonzalez Bsn, Rn, Karen Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc, Tony Rosales Dnp, Rn, Cns, Fnp-Bc

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of the project is to implement effective, convenient, and efficient weight loss counseling in today’s fast-paced mobile society. The project will reinforce current physical activity guidelines in correlation with the clinic’s standard dietary guidelines and pharmacological interventions. Patient adherence and motivation will be supported through lifestyle modification counseling via telephone.

Background: The prevalence of obese adults in the United States (US) increased from 33.7 percent in 2007-2008 to 39.6 percent in 2015-2016. Abnormal or excess weight gain may further impair health, as it correlates with the development of multiple preventable comorbidities such as cardiovascular disease, …

Audiocommunicator Reminder Phone Calls To Increase Attendance Of Well Child Visits, Taylor L. Wisner Barojas, Martha G. Fuller, Alison M. Schurman

Doctor of Nursing Practice Final Manuscripts

Background: The American Academy of Pediatrics recommends six well child checks (WCC) between 2 to 15 months. A large pediatric clinic in Southern California has an attendance rate of 86% and a very mobile population. Reminder phone calls have been shown to improve WCC attendance.

Aims of Service Change: Improve WCC attendance to >90%. As an interim step, we implemented a pilot project and measured responses to AudioCOMMUNICATOR™ reminder calls.

Outcome: In two months 148 calls were made, the majority,74%, went unanswered. 26% were able to schedule an appointment or discharge from the clinic.

Discussion: Reminder calls provide a simple …

Pain And Spiritual Distress At End Of Life, Kathryn Lee Robinson

Dissertations

Purpose: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice.

Background/Rationale: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Research is needed to examine the relationships between physical pain, spiritual distress, and other relevant variables specific to …

Frailty And Post-Operative Outcomes In Adult Hip Fracture Patients, Melissa Yager

Dissertations

Abstract

Background/ Purpose: The majority of adult hip fracture patients never return to their pre-fracture functional level and have a poor quality of life (Kistler, Nicholas, Kates, & Friedman, 2015; Pioli et al., 2016; Sheehan et al., 2018). The prevalence of frailty in adult hip fracture patients is estimated at 51%. Frail patients with hip fractures are twice as likely to have a complication (Kistler et al., 2015). Extant studies have examined frailty and hip fractures independently, nonetheless, a gap in the literature exists with few investigations of the connection between frailty and post-operative outcomes after hip fracture. The purpose …

Transforming Clinical Care Through Sexual Wellness Education For Community College Students, Chelsea Ovanek

Doctor of Nursing Practice Final Manuscripts

Abstract

Title: Transforming Clinical Care Through Sexual Wellness Education for Community College Students

Statement of the Problem: Unintended pregnancy remains a serious public health challenge throughout the world (World Health Organization [WHO], 2018). College-aged students continue to be a vulnerable population for this health issue, with estimates that 1 in 5 women will give birth before age twenty and 80% of those pregnancies unintended (Guttmacher Institute, 2019). Despite the statistics, approximately 40% of college students have received formal education on unintended pregnancy, sexually transmitted infections (STIs), or effective contraception use (Diedrich, Klein, & Peipert, 2017). According to the World Health …

Exploring The Efficacy Of A Perinatal Mental Health Community Based Organization’S Social Media Engagement, Johanna Bermudez Vera, Semira Semino-Asaro

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this project is to explore the utilization of social media outlets (Facebook and Instagram) affiliated with a local community-based perinatal mental health organization in order to inform current and future outreach and health messaging efforts by that organization. Exploring the level of engagement and associated demographics of social media users will assist the organization regarding possible expansion of their social media presence.

Background: Worldwide, 10-13% of women experience a mental health disorder such depression and/or anxiety during the postpartum period. Perinatal mood and anxiety disorders (PMADs) are associated with increased risks of maternal and infant …

A Follow-Up Phone Call To Post-Operative Patients Using The Five A’S, Brittney Ochs

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: The 2016 National Survey on Drug Use and Health reported that 53 percent of people that misused pain relievers in the past year received them from a friend or relative. The NIDA describes that from 2002 to 2008 that drug abuse in service members went from 2% to 11%. Often patients are initially prescribed and introduced to opioid medication for acute pain. One such circumstance is in the perioperative period that could provide an opportunity to promote opioid-sparing techniques to reduce the exposure to opioids.

Purpose of Project: To assess discharge medication characteristics and reinforce discharge medication instructions …

Fall Prevention Assessment In The Intermediate Care Patient Population, Dawn Rose

Doctor of Nursing Practice Final Manuscripts

Fall Prevention Assessment in the Intermediate Care Patient Population

Falls cause greater than 600,000 deaths per year and are the most common injury in people over 65 years of age. Fall prevention in the acute care setting has been identified as key goal in the most recent JCAHO review process. Falls on an intermediary care unit lead to an increased rate of morbidity, delayed discharge, and excess cost expenditure.

Even with appropriate evidence-based tools in place, Hospital A’s intermediate care unit, recorded an increased rate of falls; the highest rate in its health care system. An investigation identified factors contributing …

The Relationship Between Race And Ethnicity And Serious Safety Events In Hospitalized Patients, Samantha Crandall

Dissertations

Purpose. This study explored the association between patient sociodemographic characteristics and the occurrence of serious safety events (SSE) in hospitalized patients. Specific aims were to describe among patients who have experienced an SSE: 1) patient sociodemographic variables (age, gender, race, ethnicity and language spoken), health insurance coverage, patient zip code, payer mix, site of care location, and severity of event; 2) the relationships between the select patient sociodemographic variables, health insurance coverage, patient zip code, payer mix, site of care location and SSE level of harm; and 3) what factors increase or decrease the odds of experiencing higher levels of …

Application Of Condition‐Based Maintenance In Health Care: A Concept Analysis, Lindsey J. Ryan Phd, Rn, Acns‐Bc, Ne‐Bc

School of Nursing and Health Science: Student Scholarship

Chronic illness burdens individuals, organizations and society, costing the US $3.5 trillion annually. Transposed from the engineering industry, condition‐based maintenance is a novel concept that holds great promise for alleviating this burden by enhancing current health care delivery methods. Aims of this concept analysis include, (a) develop an operational definition for the term condition‐based maintenance and (b) discuss the applicability and effectiveness of condition‐based maintenance as applied to health care. A search of engineering and health care literature was completed. The search term “condition‐based maintenance” was entered into the PubMed, Wiley Interscience Journals, CINAHL, Journals@Ovid, ProQuest Nursing & Allied Health …

Health Care Access And Utilization By U.S. Farmworkers, Genesis Bojorquez

Dissertations

Background: Agriculture industry has the highest fatality rate among all United States industries. Farmworkers experience high rates of occupational injury, illness, and mortality, yet have limited access to health care. Implementation of the Patient Protection and Affordable Care Act (ACA) of 2010 increased health care accessibility and broadened farmworker eligibility for health insurance, yet no study has measured the impact of the ACA upon U.S. farmworkers.

Purpose: The purpose of this research was to examine health care access and health care services utilization among U.S. farmworkers following the implementation of the ACA in 2010.

Specific Aims:

1. Apply the …

An Examination Of The Night Burn Clinic Transition To Nurse Practitioner Coverage, Kevin J. Maxwell Dnp, Fnp-Bc

Dissertations

Background/Significance: Burns are dynamic, evolving wounds requiring prompt attention and treatment (Morgan et al., 2018). Many studies have been conducted comparing physician outcomes to those of APNs showing no difference (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2011; Naylor & Kurtzman, 2010; Pioro et al., 2001; Roche, Gardner, & Jack, 2017; Spetz, Skillman, & Andrilla, 2017). Time delays which allow for progression of the injury have a negative impact on patient outcomes. Any pathway allowing for quicker review of the burn by a burn specialist should be welcomed (Kelly et al., 2013). APNs can augment physician efforts and expand access to …

Treatments For Cancer Given Orally: Patients' Perceptions Of Distress Due To Financial Toxicity, Ellen Carr

Dissertations

Purpose/Aims: For adult participants who have received or are receiving treatment for hematologic and solid tumor malignancies given orally, this study describes the relationship between participants’ experience of financial toxicity (FT), the participants’ perception of distress associated with FT, and participants’ self-identified adherence to prescribed treatments in the context of FT.

Background: FT has emerged as an additional source of distress for cancer patients. The costs of treatments given orally can be prohibitively expensive for patients. Therefore, these patients may experience considerable distress and may not adhere to treatments as prescribed.

Method: Descriptive cross-sectional correlational design study of a sample …

Achieving Access Parity For Inpatient Psychiatric Care Requires Repealing The Medicaid Institutions For Mental Disease Exclusion Rule, Briony Marie Dubose Mhi, Rn, Lss Bb, Eileen K. Fry-Bowers Phd, Jd, Rn, Cpnp, Faan

School of Nursing and Health Science: Faculty Scholarship

Approximately 3.4% of Americans have a mental health condition and suicide is the 10th leading cause of death. While the rate of mental health conditions has slightly increased for adult populations, America’s youth has experienced a significant rise in depression. From 2008 to 2017, occurrence of depression in the adolescent population increased from 8.3% to 13.3%. As adolescents mature into adults; it is likely the rate of mental health conditions for the adult population will rise as well as it is the common thread that binds the “diseases of despair”: drug abuse, alcoholism and suicide.

Arising out of the deinstitutionalization …

Patient-Specific Factors Associated With Surgical Delay In A Large Academic Hospital, Natalie Meyers

Dissertations

The high cost of healthcare is driving the search for more efficient practice, especially in high-stakes locations like the operating room. In addition to financial losses, patients suffer physical and emotional distress, including an increased risk of morbidity or mortality when surgical cases are delayed due to inefficiency. While patient-related causes of delay have been implicated, it is unclear which specific factors are most significant. This study aimed to identify specific patient factors correlated with surgical delay and develop a predictive risk algorithm that describes the relationship between patient-specific factors and surgical delay.

A retrospective review of 36,543 patients’ charts …

Factors Related To 30-Day Readmission Among Hispanics With Type 2 Diabetes, Athena Mohebbi

Dissertations

Background: Medicare spends $17 billion yearly on 30-day readmissions. Hispanic adults have a higher prevalence of diabetes (12.6%) compared to non-Hispanic whites (9.4%). Those with a diagnosis of diabetes have the 17% higher rate (14-23%) for 30-day readmission. Little research has been conducted on Hispanics with diabetes relative to 30-day readmissions. Aims: Among Hispanics with type 2 diabetes: 1) measure the incidence of 30-day readmission by sociodemographic, behavioral and clinical factors;2) identify independent factors associated with 30-day readmission among Hispanic adults with type 2 diabetes accounting for potential covariates; 3) compare the ability of the Hispanic Diabetic Study Model plus …

Sample Dnp Project Criteria, Ann M. Mayo Rn, Dnsc, Faan

School of Nursing and Health Science: Faculty Scholarship

These sample criteria for Doctorate of Nursing Practice (DNP) projects will be helpful to DNP faculty and students alike. Many nursing faculty teaching in DNP programs have never conducted an Evidence-based Practice Project and so the criteria are meant to be a guide for their learning and help to differentiate DNP projects from research. Research criteria should not be used for DNP project planning or evaluation. Students will benefit from the criteria as they plan and carry out their projects. Criteria should be supplemented by reading examples of strong EBP projects. Readers should critique such publications using the DNP criteria …

Reliability And Validity Measurement Issues: Nothing New To Clinical Nurse Specialists; But Liability Issues Too?, Ann Mayo Rn, Dnsc, Faan

School of Nursing and Health Science: Faculty Scholarship

Reliability and validity measurement issues are nothing new to clinical nurse specialists (CNS). Over the years, this journal has published a plethora of articles addressing measurement, and as students, CNSs were educated programs about the importance of reliability and validity as applied to instrument selection, usage and interpretation of scores. As a result, healthcare organizations know that their CNSs are the go-to professionals when a process or outcome needs to be measured. A recent announcement from the Montreal Cognitive Assessment (MoCA) Clinic and Institute demonstrated the importance of liability as a third element to be considered when selecting and using …

Enhancing Chronic Pain Management Motivational Interview Among Lower Back Pain Patients, Melissa L. Hines-Antico

Doctor of Nursing Practice Final Manuscripts

Purpose: Untreated chronic pain is a nationwide epidemic affect individual physically, psychologically, and financially. Low back pain is the most common subset of chronic pain. Restricted clinic time and a focus on procedural/prescriptive methods for managing pain prohibits patient education regarding self-care, and formation of a relationship with the provider.

Design: Article review yielded 20 articles that supported the use of motivational interviewing for chronic pain in lower back pain patients. They were evaluated for their strength of evidence on a scale of 1-6. One article was ranked level I as a meta-analysis, and six were ranked as level II …

Implementation Of An Evidenced-Based Concussion Management Protocol Utilizing Telemedicine In A Student Health Center, Shelly Benfield

Doctor of Nursing Practice Final Manuscripts

Background: An estimated 3.8 million concussions occur yearly in the United States and the incidence of youth concussions is on the rise. If untreated or unrecognized, more serious complications of concussions include post-concussion syndrome, second impact syndrome, and chronic traumatic encephalopathy. Clinic leadership in a southern California student health center identified systematic inefficiencies and noted a lack of standardized follow-up concussion appointment times which resulted in decreased clinic efficiency.

Purpose: The purpose of this evidenced-base project was to implement an effective concussion protocol and follow-up treatment plan that would improve clinic efficiency without negatively impacting concussion outcomes.

Evidence-based Interventions: A …

Patient Perception Of Fall Risk And High Fall Risk Screening Scores, Nicole D. Pena

Dissertations

Purpose: The purpose of the study was to describe the relationship between patient

perception of fall risk and high fall risk screening scores.

Background: Despite mandated government regulations and multiple hospital

interventions, falls are the most prevalent adverse event among hospitalized patients and

are the leading driver of health care costs, amounting to over $30 billion each year with

projections to double by 2030. Recently, perception was identified as a major component

in preventing falls. A dearth of research examines the relationship between a patient’s

perceived risk for falls and standardized fall screening scores.

Methods: A descriptive correlational design with …

Managing Childhood Atopic Dermatitis: Utilizing A Written Eczema Action Plan To Improve Caregiver Self-Efficacy, Tiffany Sena

Doctor of Nursing Practice Final Manuscripts

Approximately 13% of the pediatric population suffer from atopic dermatitis (AD) or eczema (Silverberg & Simpson, 2014). Eczema is a complex and costly managed disease. There is a need to improve caregiver knowledge and to maintain and control exacerbations as national prevalence increases in the United States. Literature supports utilization of a written Eczema Action Plan (EAP) to improve caregiver self-efficacy of eczema management. An evidence-based practice project was conducted in a primary care pediatric practice implementing a written EAP for mild to severely diagnosed patients ranging from 4 months to 17 years of age. The practice intervention included providing …

Implementing A Trigger-Based Model For Early Palliative Care Consultation On A Medical Oncology Floor, Hsiu Jan Chen

Doctor of Nursing Practice Final Manuscripts

Background: A systematic review by Wendlandt et al. (2012) showed that 84% of the providers referred their patient to palliative care (PC) at a very late stage for uncontrolled symptom management. Significant barriers included a lack of training, lack of recognized referral criteria, lack of a referral protocol. A delayed PC referral can result in prolonging patient suffering from symptom distress, avoidable laboratory work in addition to unnecessary aggressive medical treatment.

Purpose of Project: This Evidence-based Practice pilot project is aimed to facilitate an early PC consultation on an oncology medicine floor by implementing a Palliative care (PC) …

Missed Shots: Increasing Flu Vaccine Documentation Utilizing A Clinical Reminder In A Student Health Clinic, Noelle Simms

Doctor of Nursing Practice Final Manuscripts

Objectives: The primary purpose of this evidence-based practice project is to increase influenza vaccination documentation in the student health setting utilizing a standardized clinical reminder.

Participants: 1,337 undergraduate and graduate students at a private university is Southern California.

Methods: A clinical reminder template was created and added to the intake form in the electronic medical record. The medical assistants complete the template with the patient. The provider then orders the vaccine or educates the patient based on the documented refusal reason.

Results: During the 10-week implementation period there was a 46% increase from baseline in flu vaccine documentation at the …

Herpes Zostervaccine To The Homebound Elderly: Prevention, Protection, And Access To Care, Serena Arts

Doctor of Nursing Practice Final Manuscripts

Herpes Zoster Vaccine to the Homebound Elderly: Prevention, Protection, and Access to Care

Purpose: To increase the administration rate of the Herpes Zoster (Hz) vaccine Zostavax by 10% for persons 65 years and older in a home-based primary care practice, utilizing Medicare part D.

Background: Persons in the United States (US) age 40 years and older show a 99% positive serology for Varicella, which causes Hz decades later. Zostavax has been shown to decease Hz by 51% and post-herpetic neuralgia by 67%.

Brief Description: The goal of Healthy People 2020 is to increase the vaccination rates of persons 65 years …

Remifentanil Patient Controlled Analgesia Use In Laboring Women: A Feasibility Pilot Project, Joshua Aaron Carr

Doctor of Nursing Practice Final Manuscripts

Labor pain is a significant source of anxiety for most pregnant women. Parturients who are excluded from epidural analgesia (EA), the most common and most effective technique to reduce this pain, deserve access to the next best choice. Remifentanil patient controlled analgesia (RPCA), due to its fast onset, short half-life and demonstrated effect at reducing pain and boosting satisfaction is the next best option when compared to EA. Adoption of this strategy represents an opportunity to help bring this evidence based technique into a mainstream health system. This project reports on the first stage of a pilot project to bring …

A Shared Medical Appointments For The Two-Week Well Child Visit, Sarah Anderson, Jennifer Eng-Kulawy Md, Faap, Joseph Burkard Dnsc, Crna

Doctor of Nursing Practice Final Manuscripts

Background: The World Health Organization (WHO), American Academy of Pediatrics (AAP), and the literature supports exclusive breastfeeding for newborns until six months of age and continued breastfeeding until 12 months of age. Postpartum maternal breastfeeding support has been insufficient in the pediatric clinic to support exclusive breastfeeding recommendations. Shared Medical Appointments (SMA) are an alternative approach to individual well-child appointments that provide lactation consultants sufficient time to conduct breastfeeding education during the extended appointment.

Objective: Through utilization of a shared medical appointment (SMA), a southern California military pediatric clinic will increase exclusive breastfeeding rates (EBF) of new mothers by 10% …

Understanding The Impact Of A Perinatal Mood And Anxiety Disorders Phone Support Line, Diana Nguyen, Semira Semino-Asaro

Doctor of Nursing Practice Final Manuscripts

Postpartum depression affects one in every seven women and anxiety is estimated to range from 13-21% in new mothers. Risk factors include prior diagnosis of depression, family history of depression, having medical complications during childbirth including a premature baby and a lack of social, emotional support. The purpose of this evidence-based practice project was to increase the amount of data gathered by a local perinatal support organization by analyzing the callers’ demographics through phoneline surveys and use the information to expand resources and access to care for mothers with perinatal mood and anxiety disorders (PMADs). The project was guided by …

Using Short Message (Sms) To Deliver Appointment Reminders And Reduce No-Show Rates: An Evidence-Based Practice Project, Fernando Serrano

Doctor of Nursing Practice Final Manuscripts

Background/Objectives: Missed appointments (MAs) are correlated with reduced treatment efficacy, increased financial burden on medical institutions, and early treatment terminations for therapy (DeFife, Conklin, Smith, & Poole, 2010). MAs occur for a variety of reasons including, but not limited to severity of illness, financial/geographic constraints, and forgetting the appointment (Filippidou, Lingwood, & Mirza, 2014). Appointment compliance within outpatient mental health clinics has a wide variance with some clinics reporting MAs ranging from 15% to 50% (Car, Gurol-Urganci, de Jongh, Vodopivec-Jamsek, & Atun, 2013).

With decreasing costs and a subsequent massive increase in mobile phone technology use by the general population, …