Nursing Commons^™

Telephone Calls To Reduce 30-Day Readmissions For Older Adults With Heart Failure, Juanette G. Clark

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidenced based practice project was to evaluate the effectiveness of discharge follow-up calls for heart failure (HF) patients recently discharged from a private hospital.

Background: HF is the number one discharge diagnosis among patients 65 years and older. It affects 5.8 million people in the United States. HF admissions total (1) million annually, however, 24% of these patients are readmitted within 30 days of discharge. Re-hospitalizations are associated with high mortality rates and expenditures approximated at $13,000 per patient contributing to the overall annual expenditure of $33.7 billion. In 2012, the Centers for Medicare …

Evaluating Physical Therapy For Adolescent Patients With Low Back Pain, Kelly Denise Gonzales

Doctor of Nursing Practice Final Manuscripts

Background: Low back pain is a condition affecting many people worldwide. The age of onset is variable, affecting all patient populations from childhood throughout the lifespan. Aims/Purpose: The efficacy of physical therapy for adolescent patients with back pain seen in a pediatric orthopedic clinic was evaluated through comparison of pre and post-intervention pain scores. Patient compliance with physical therapy was monitored and evaluated against outcomes.

Design: A six-month retrospective chart review of adolescent patients with a diagnosis of low back pain. Patients with a diagnosis of low back pain were referred for physical therapy and provided with a home exercise …

Heart Failure Patient Self-Care: An Evidence-Based Outpatient Management Program, Christine Marie Ensign, Shelley Hawkins, Barry Greenberg

Doctor of Nursing Practice Final Manuscripts

Background: According to the American Heart Association, there are over 5 million people in the United States with heart failure (HF) and projections suggest the prevalence of HF will increase by 46% through 2030. HF is the most common cause of hospital admissions in the United States for patients age 65 years or older and despite improvement outcomes, national readmission rates remain high at 23%. Current guidelines recommend health professionals provide comprehensive HF education and counseling that is not only focused on knowledge, but also on skills of management and self-care behaviors. In order to achieve quality patient-centered care, …

Transition After Breast Cancer Treatment: Implementing Survivorship Care Plans, Susan Hope Klein

Doctor of Nursing Practice Final Manuscripts

The success of cancer treatments have resulted in a rapid growth of survivors, providing the impetus for the oncology community to examine models of care supporting smooth transition from active treatment to survivorship care. While initially a recommendation of the Institute of Medicine, treatment summaries and survivorship care plans are now an accreditation requirement for many organizations. This article describes the implementation of an evidence based practice project designed to meet these standards while improving the knowledge and satisfaction of a population of breast cancer patients at a community-based oncology practice.

Improving Utilization Of 2012 Asccp Guidelines In A Family Practice Setting, Michelle M. Mccormick, Mary Barger

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project is to decrease unnecessary colposcopy referrals using provider education and user friendly tools. This is accomplished by increasing utilization of the 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines at a Military Treatment Facility Family Practice Clinic. Despite clear cervical cancer screening guidelines, nationwide, women are continuing to have unnecessary Pap testing regardless of HPV status. Over screening can result in an increase in false positive results, leading to rising healthcare costs, additional office visits, and stress to the patient from procedures that yield little useful information or decrease in morbidity. Although …

Emergency Protocol Program For High School Athletes, Casandra B. Moyer

Doctor of Nursing Practice Final Manuscripts

This evidence-based project (EBP) involved development and implementation of an emergency protocol (EP) education program for high school athletes and coaches at a southern California high school. A Doctor of Nursing Practice student, collaborating with health care and athletic personnel, conducted an assessment of the high school’s EPs for management of asthma, anaphylaxis, diabetes, and heat illness. Then, an EP and educational program were created; coaches and athletes were educated on the protocol during a coaches’ meeting and practice times, respectively. All participants completed pre- and post-tests, and mean knowledge scores were compared. The overall knowledge score increased by 10% …

Instituting Patient-Self Test Meters In Adults On Warfarin In A Cardiology Practice, Melvyn Grace Manzano Rabanal

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the oral anticoagulant that is most commonly used to control and prevent thromboembolic disorders. It requires meticulous testing and dosing adjustments to attain therapeutic international normalized ratio (INR) levels. Patient self-testing (PST) is associated with a reduced risk of all-cause mortality and lower rates of thromboembolism and bleeding. PST meters offers convenience and promotes self-initiative of care.

Purpose: The purpose of the project is to evaluate the effectiveness of INR PST in adult patients diagnosed with atrial fibrillation, deep vein thrombosis, and mechanical heart valve on warfarin therapy in a Cardiology practice compared to traditional …

Reducing Antipyretic Use For Low-Grade Fevers In Otherwise Healthy Children, Tricia A. Templet

Doctor of Nursing Practice Final Manuscripts

Fever phobia is persistent in the pediatric population, as fever is a common complaint for advice calls, sick visits, and urgent care/emergency department utilization. Fever phobia among parents and healthcare providers is evidenced by the quest to return a child to normothermia. Fevers under 38.5ºC (101.3ºF) are considered benign in healthy children, usually requiring no pharmaceutical intervention. Research consistently demonstrates pediatric nurses inappropriately medicate patients for low-grade fevers. The purpose of this evidence-based practice project was to identify knowledge of the benefits and myths of fever in otherwise healthy children and to decrease the use of antipyretics for low-grade fevers …

Improving Asthma Symptoms Using Asthma Action Plans, Ryan Daniel Thebo, Michael Terry

Doctor of Nursing Practice Final Manuscripts

Asthma is a chronic disorder characterized by airflow obstruction, causing chest tightness, wheezing, coughing, and shortness of breath. In California, 7.9% of patients have an asthma diagnosis. The 2007 NHLBI Expert Panel Report 3 recommended using asthma action plans in asthma management (NHLBI, 2007). Patients with asthma were taught to use an AAP to improve asthma control. Overall, 80% of patients improved by at least one EPR3 asthma control category.

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

Improving Hpv Vaccinations In Military Women, Sarah Beth Wedel

Doctor of Nursing Practice Final Manuscripts

Project Purpose: The purpose of the project was to implement Human Papillomavirus (HPV) patient education during every well woman exam (WWE) to improve patient knowledge and HPV vaccination rates in military women aged 18-26 years.

Background: The Human Papillomavirus (HPV) has been identified as the biggest risk factor for cervical cancer and, despite the availability of a vaccine; HPV continues to be the most common STI in the U. S. (American Cancer Society, 2013). Approximately 79 million Americans are currently infected with HPV, and 14 million individuals will become infected annually, leading to more than 10,000 cases of cervical cancer …

Supporting Self-Management In Veterans With Chronic Pain: A Policy Perspective, Erin W. Lind

Doctor of Nursing Practice Final Manuscripts

The purpose of the project was to do an evidence-based review of the effectiveness of promoting self-care on pain levels and quality of life among veterans with chronic pain at a national level. A review of current chronic pain management policies for veterans in southern California was also conducted. Active self-management initiatives permit more diverse, patient-centered treatment, promote self-management, and are relatively safe and cost-effective. Our results have confirmed that chronic pain is on the forefront of priorities for the Veterans Health Administration (VHA) due to an increasing rate of both chronic pain and opioid overdoses.

Biomechanics Of Lower Limbs During Walking Among Candidates For Total Knee Arthroplasty With And Without Low Back Pain, David R. Burnett, Naira N. Campbell-Kyureghyan, Robert V. Topp, Peter M. Quesada

School of Nursing and Health Science: Faculty Scholarship

The effect of joint pathologies, such as unilateral knee osteoarthritis (UKOA) or low back pain (LBP), on bilateral gait symmetry has gained increased attention during the past decade. This study is the first to compare gait patterns between patients with UKOA and LBP in combination and with UKOA only. Temporal, kinematic, and kinetic variables were measured bilaterally during gait stance phase in 31 subjects with UKOA and LBP (Group I) and 11 subjects with only UKOA (Group II). Group I patients exhibited less hip rotation in the affected limb (A) than in the nonaffected (NA) limb during walking in contrast …

Transitional Care Of Adult Patients With Diabetes Following Hospitalizations, Eric Tobin

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project was to incorporate a diabetes transitional care program using group visits to improve self-care management behaviors and glycemic control in diabetic patients at a southern California hospital.

Background: Diabetes is a challenging healthcare problem associated with significant mortality and morbidity issues. In 2012, 29.1 million people, or 9.3% of the U.S. population, were diagnosed with diabetes, and 28.9 million of those patients were 20 years of age and older. Today, diabetes is of epidemic proportion worldwide, and a projection of 5.4% of the adult population will have diabetes by 2025. The …

Psychometric Instrumentation: Reliability And Validity Of Instruments Used For Clinical Practice, Evidence-Based Practice Projects And Research Studies, Ann Mayo Rn, Dnsc, Faan

School of Nursing and Health Science: Faculty Scholarship

Clinical Nurse Specialists and other advanced practice nurses (APNs) are relied upon for their expert data based decision-making to ensure excellent clinical practice, high quality evidence-based practice projects, and efficacious research studies. Using measurement instruments to collect data that lack reliability and validity can compromise decisionmaking leading to deleterious results for patients, nurses, and healthcare organizations. The ultimate goal is to choose reliable instruments that produce valid data so that clinical trends, project evaluations, and research findings are trustworthy. Determining the quality of a given instruments is most often done through a critique process. Critiquing potential instruments for use is …

Patients' Perception Of Feeling Known By Their Nurses And The Nurse Practice Environment, Deene' L. Mollon

Dissertations

Healthcare leaders have a responsibility to understand the connection between healthy practice environments and patients’ perceptions of care. The purpose of this research was to explore the relationship between the nurses’ perception of the practice environment and the patients’ perception of feeling known by their nurses.

This descriptive, correlational study used quantitative and qualitative methodology. A convenience sample of 123 patients, on six patient care units, completed the Patients’ Perception of Feeling Known by their Nurses Scale and a supplemental survey designed to determine the content validity of the Patients’ Perception of Feeling Known by their Nurses Scale. To …

Clinical Effectiveness Of Inr Patient Self-Testing: Adults On Warfarin Therapy In Private Practice, Anisa Munshi

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the most commonly prescribed oral anticoagulant for the prevention and treatment of venous thromboembolism. Due to its narrow therapeutic index, warfarin requires close monitoring of the international normalized ratio (INR) to ensure proper anticoagulation control and safety. INRs outside of this range are strongly associated with an increased risk of major bleeding, thromboembolic events, and death. Patient self-testing (PST) using a point-of-care device allows patients to monitor INR results at home. Evidence shows that PST improves the clinical outcomes of warfarin therapy compared to usual care, which includes laboratory INR monitoring. Purpose: To compare the clinical effectiveness …

Knowledge Of Stroke Symptom And Risk Factors And Acculturation Among Cambodian Immigrants Living In Southern California, Samantha N. Sangsanoi-Terkchareon

Dissertations

The purpose of this quantitative study was to describe and examine the relationships between age, gender, educational level, health insurance status, and income to level of acculturation and knowledge of stroke symptom and risk factors recognition among Cambodian immigrants (n=200) living in Southern California. The data were analyzed using Pearson correlation, Kendal Tau, Chi-Square, and multiple regression to the determine relationship between depend and independent variables. The results of this study were that Cambodian participants’ mean age was 46.07 (SD= 17.51), average years of education were 8.95 (SD=5.26) and the mean number of people in each household was …

Onsite Integrative Clinics: Acupuncture, Positive Patient Outcomes, And Frequency Of Provider Office Visits, Sherry Shoemaker Phd

Dissertations

Purpose and Aims. There is limited information about outcomes of care, resource utilization, and associated costs for patients who receive acupuncture in integrative health settings. The purpose of this study was to address this gap through the following aims: To examine: (1) changes in patient pain levels pre/post acupuncture treatments; (2) relationships between receiving acupuncture treatments (number of treatments, length of time, select demographic factors, (age, gender), pain level pre and post acupuncture treatments; (3) relationships between number of treatments, length of time, age, gender, pain level (pre/post acupuncture treatments) and provider visits (pre/post acupuncture treatments); and (4) relationship between …

Exploring A Diabetic Registry For Cardiovascular Risk Factors, Mary C. Anziano Phd

Dissertations

Background: Cardiovascular disease is the leading cause of death in the United States. There were over 18 million people diagnosed with diabetes in 2002. These disease processes together combine for significant health burden on society (American Diabetes Association, 2008). The purpose of the study was to describe the relationship between select demographics, and clinical characteristics to determine risk factors for cardiovascular disease in a diabetic population. Methods: A retrospective descriptive study was conducted using a diabetic registry database containing patients diagnosed with diabetes from January 1, 2011 to December 31, 2012. Study variables included age, gender, socio-economic status, glycosylated hemoglobin …

The Case Of Reintegration Of Women Post Incarceration, Deana Raley Noble Phd

Dissertations

Women released from prison or jail face particular obstacles and challenges on reentry to the community, many of which are related to their childhood and to gender roles as women and mothers. This study relates the lived experience of one woman's successful transition to economic and mainstream societal reintegration and family reconnection after release from prison and the insights gained by the researcher. Case study methodology congruent with Miller's Relational-Cultural Theory philosophical framework was utilized in this in-depth, single case design and represents a unique case. The overall purpose of this descriptive and explanatory research was to explore precursors to …

Relationship Between Age And Pre-End Stage Renal Disease Care In Elderly Hemodialysis Patients, Rubette Harford Phd, Msn, Rn

Dissertations

Purpose: The primary purpose of this dissertation was to examine the relationship between age and receipt of three components of pre-end stage renal disease care prior to first initiation of hemodialysis, and to explore the implications of differences in interpretation of funding policies for dialysis services in Puerto Rico and the U.S. mainland. Background: The growing burden of chronic kidney disease (CKD) is a national public health concern, particularly within the aged population. It is estimated that more than 25 million Americans are living with some level of kidney disease, with an increasing prevalence noted with increasing age (Coresh et …

Depressive Symptomatology And Perceived Social Support In Adolescents With Type 2 Diabetes, Kristiana Gay Huffman Cullum Phd, Cpnp

Dissertations

Type 2 diabetes has increased dramatically in the pediatric population in the last decade. One of the comorbidities of diabetes is depression. In the presence of depression, diabetes may be mismanaged by patients and lead to a decline in health. Diabetes with comorbid depression may have better disease management outcomes in the presence of higher levels of social support. Defining childhood depression, which encompasses adolescence, and the subtleties of this disorder compared to the adult counterpart, was needed to better delineate important variables for this research study. There are several instruments that evaluate adolescents' perceived social support, but a fairly …

Symptom Burden And Healthcare Utilization In Pulmonary Arterial Hypertension, Catherina Anne Madani Phd

Dissertations

Background: Pulmonary arterial hypertension (PAH) is a rapidly progressive disease. There is currently no cure; thus treatment is aimed at prolonging survival, improving functional status (FS), and symptom mitigation. Symptom burden (SB) can impact quality of life (QOL), and lead to increased healthcare utilization. Palliative care (PC) has been associated with higher QOL, decreased depression, aggressive care, and mortality. The Institute of Medicine's (IOM) recent report supports earlier integration of PC for people living with serious illness. Detection of patients at high risk for heavy SB may help to identify patients who could benefit from earlier integration of PC into …

Patients With Advanced Lung Cancer: Quality Of Life And Perception Of Dyspnea, Barbara A. Roces Phd, Msn, Np, Rn

Dissertations

Background: Dyspnea perception can be defined as a multidimensional experience of breathing discomfort, influenced by physiological, psychological, social, and environmental factors, that includes secondary psychological and behavioral responses and cannot be defined only by physical objective abnormalities (Mularski et al., 2010). Dyspnea is the most common and distressing symptom in patients with advanced lung cancer and decreases one's quality of life (QOL) (Smith et al., 2001). Furthermore, dyspnea has been found to interfere with physical activities such as walking, work, and psychological activities such as disposition, taking pleasure in life, relationship with others, and sleep (Tanaka, Akechi, Okuyama, Nishiwaki, & …

Patient Care Technology And The Nurse-Patient Relationship, Belinda M. Toole Phd, Msn, Rn

Dissertations

Background: Technological devices are increasingly used in healthcare and their proliferation has providers questioning the impact on the patient-provider relationship. Technological device integration has been studied in the primary care setting, less extensively in the acute care setting. The impact of device use on the nurse-patient relationship in acute care setting required further study, particularly with nursing's history of holistic practice incorporating caring and presence. Objectives: The study purpose was to explore the patient's perceptions of nurse caring and presence when technological devices were used in care delivery in the acute care setting. Specific aims were: 1) to describe the …

Skin Cancer Risk Perception And Sunscreen Use In Adolescent Female Soccer Athletes, Cheryl L. Butera Phd, Msn, Aprn, Fnp-Bc, Np-C, Phn

Dissertations

Over 3.5 million cases of skin cancer are diagnosed annually in the United States. In adolescent females ages 15-19, melanoma is the second most common form of cancer. The greatest risk factor for skin cancer is ultraviolet rays from the sun. Research has shown that sunscreen use is protective of all skin cancers, especially melanoma. The purpose of this study was to obtain perceptions about risk of skin cancer and sunscreen use among 13- to 18-year-old adolescent female club soccer athletes as a basis for effective interventions to improve sunscreen use in this population. The Health Belief Model was employed …

Nurse Practice Environment And Peripheral Intravenous Infiltrations In A Pediatric Hospital On The Magnet Journey, Jannise Topacio Baclig Phd

Dissertations

Background: Characteristics such as quality patient care, excellence in nursing, and innovations in professional nursing practice shape a health care organization into a "magnet" organization. Magnet designation is a key aspect of nursing, which places pressure on healthcare organizations to commit to nursing excellence and patient care should they take the challenge of attaining this prestige. With growing focus on quality and safety, nursing needs to remain diligent in ensuring a healthy work environment that not only supports the profession, but also sustains exceptional patient outcomes. The purpose of this research study was to describe the relationship of the nurse …

Efficacy Of Mantram Repetition Program On Sleep In Veterans With Posttraumatic Stress Disorder, Lindsay Cosco Holt Phd

Dissertations

Posttraumatic Stress Disorder (PTSD) affects over seven million (3.5%) of the US adult population. In 2011, 476,515 veterans were currently seeking treatment for PTSD. Statistics show that 87% of veterans with PTSD report sleep disturbances and 52% experience frequent nightmares, making sleep the second most common reason why veterans seek mental health care upon return from deployment (Germain et al., 2006). Studies have sought to find a link between PTSD and sleep, and the importance of sleep in the recovery process, but there is a gap in the research on sleep disturbances and interventions for improvement in veterans with PTSD. …