Assessing And Evaluating Health Literacy Practices In The Ambulatory Setting, Anne Marie Koch

DNP Projects

Purpose: The purpose of this study is to assess health literacy knowledge and practices among ambulatory care providers who care for patients with type 2 diabetes.

Methods: Healthcare professionals who provide diabetes care and education were invited to participate in a health literacy education session with a pre and post-intervention knowledge survey. A retrospective chart review was conducted to evaluate health literacy practices in three PCP and three endocrinology offices. An evaluation of health literacy practices was used to compare PCP and endocrinology practices and determine if health literacy practices correlated to controlled hemoglobin a1c values.

Results: …

Tne Effect Of In Our Own Voice On Stigma In Bsn Students, Stephanie Steele

DNP Projects

Stigma regarding mental illness is common throughout the world, and can lead to social isolation, low self-esteem, loss of income and employment, deterioration of life quality, impeded access to medical care, and a shorter lifespan for people diagnosed with a mental illness (Cleary, Deacon, Jackson, Andrew, & Chan, 2012; Corrigan et al., 2013). The purpose of this DNP project was to provide an evidence-based intervention called In Our Own Voice (IOOV) to first semester sophomore nursing students and assess its impact on their perceptions of mental illness stigma. Alterations in stigma were assessed through the Attribution Questionnaire-27 administered to students …

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 …

The Evaluation Of The Impact Of Controlled Substance Patient Education In The After Visit Summary On Patient Knowledge Of Controlled Substance Medication, Marie Honeycutt

DNP Projects

The use of opioids is associated with risks for misuse, abuse, addiction and diversion, which are directly related to increased healthcare utilization, increased healthcare cost, and poor patient outcomes. The purpose of this study was to evaluate the impact of controlled substance (CS) patient education that was implemented into the electronic medical record. The objectives were to 1.) assess whether patients received the CS after visit summary (AVS) and 2.) assess differences in pain management knowledge between those who received the AVS and those who did not. Methods This descriptive correlational designed study examined the differences in pain management knowledge …

An Examination Of Primary Care Providers’ Assessment And Plan Of Care For Children And Adolescents Who Are Overweight Or Obese, Kevin Pinto

DNP Projects

Background: Childhood and adolescent obesity rates have more than tripled since the 1970s. Currently in the United States, one in five children is obese (6-19 years of age). It is important to identify children and adolescents who are overweight or obese because early intervention may help to reduce the long-term implications of obesity. The purpose of this project was to examine how often pediatric primary care providers diagnosed overweight or obesity and created a plan of care for children 6-17 years of age who were overweight or obese. Facilitators and barriers to diagnosing and creating a plan of care were …

Evaluation Of The Crafft Substance Use Screening Tool In Primary Care, Leanne Coleman

DNP Projects

PURPOSE: The purpose of this research study was to evaluate the use of the CRAFFT tool within a pediatric primary care setting. The specific objective was to assess the frequency of documentation of substance use screening, counseling, and/or intervention before and after the implementation of the CRAFFT tool.

METHOD: The practice site chose to implement an evidence based adolescent substance use screening tool (CRAFFT Tool) to improve practice. This practice improvement project utilized a descriptive design with a review of electronic medical records before and after a substance use screening tool was implemented. Two hundred medical records were reviewed, 100 …

The Effect Of A Provider Education Program On Tobacco Use In An Adult Population In The Primary Care Setting, Sunita Gurung

DNP Projects

PURPOSE: The purpose of this study was to evaluate the effectiveness of an education session to promote adherence to the United States Preventive Services Task Force (USPSTF) recommendation and Clinical Practice Guidelines for Treating Tobacco Use and Dependence by providers.

METHODS: A retrospective and prospective record review was used to evaluate an education session for providers in tobacco use screening, providing cessation counseling, prescribing medication for tobacco cessation, and sending out referrals for tobacco cessation at one primary care clinic in Louisville, KY. Education sessions were held from August 1, 2018 to August 14, 2018. The sample consisted of 200 …

The Impact Of The Nurse Practitioner In Pre-Admission Testing: A Comparative Review, Laurel A. Robinson

DNP Projects

Abstract

PURPOSE: The purpose of this study was to compare the efficiency of pre-admission testing (PAT) surgical clinic pre and post implementation of the APRN for patient assessment. Cancellation and delay occurrences for scheduled surgeries will be compared during two time periods on patients on the surgical schedule at Norton Women and Children’s Hospital (NWC).

METHODS: This study was a single-center, pre and post implementation retrospective comparative study of the impact of the NP led PAT unit at Norton Women and Children’s Hospital (NWC) in terms of delay and cancellation rates for day-of-surgery. The sample consisted of 411 patients for …

Risk For Depression In Coronary Heart Disease Patients Meriting Post-Coronary Artery Bypass Graft Screening; Feasibility Of Nurse-Led Cognitive Behavioral Therapy Among Patients With Depressive Symptoms, Joy L. Coles

DNP Projects

PURPOSE: The purpose of this Doctor of Nursing Practice (DNP) project was to implement depression screening with the Patient Health Questionnaire-9 (PHQ-9) among patients with Coronary Heart Disease (CHD) who have undergone a Coronary Artery Bypass Graft (CABG) and demonstrate the feasibility of a nurse-led Cognitive Behavioral Therapy (CBT) intervention.

METHODS: A non-experimental pre-test and post-test design was completed to screen for depression among patients post CABG in the Cardiovascular Intensive Care Unit (CVICU) at a University Hospital using the PHQ-9. A sample of 21 patients were identified and selected from a convenience sample by pulling every eligible record from …

Diabetes-Related Distress Screening: A Survey Of Primary Care Providers' Knowledge, Attitudes, And Practices In Treating Patients With Difficulty Meeting Glycemic Goals., Michele Patrice Paxton

DNP Projects

A patient with diabetes is two to three times more likely to be depressed than the general population. Furthermore, the combination of diabetes and depression is associated with increased morbidity and mortality. However, research has shown that treatment for depression does not correlate with lower HbA1c levels or a decrease in morbidity and mortality. Recently, a body of evidence has shown that increased HbA1c levels and depression are associated with the emotional burden of managing diabetes. The emotional burden is caused by the constant behavioral and mental demands of managing the disease and the worry and fear of the impending …

Methods To Improve Interprofessional Collaboration In Administrative Dyads, Julie Lee Hudson

DNP Projects

Abstract

PURPOSE: The primary objective of this project was to determine if specific interventions, to include education, rounding, and regular meetings, improved collaboration and communication for nurse/physician dyads working in acute care hospital administrative roles.

METHODS: The study employed a prospective pre-test and post-test comparison of participants’ scores on a validated survey tool. This tool (JeffSATIC) measured perception of collaboration between nurses and physicians. The objective was to evaluate the differences in these scores in participants before and after an intervention.

RESULTS: This study sought to discover if specific interventions impacted scores on a tool measuring collaboration among dyad pairs. …

A Quality Improvement Project To Improve Blood Specimen Acceptance Rates In An Emergency Department, Christian Hankins

DNP Projects

Purpose: The purpose of this project was to implement a quality improvement project to improve blood specimen acceptance rates at a specific Emergency Department (ED) using strategies to enhance knowledge, improve motivation, and reinforce skill. Background: Specimen acceptance rates continue to fall outside of the recommended target rate of 98% or higher at a specific ED. In this particular ED, the responsibility for specimen collection has shifted away from phlebotomists and towards nurses, many of whom have received little to no phlebotomy training. Without proper blood collection techniques, specimens are more likely to be rejected, and re-collection of rejected blood …

The Effect Of Mindfulness Meditation On Perceived Stress And Total Health Care Cost, Rachel Hale

DNP Projects

Background: Chronic stress can lead to hypertension, tachycardia, and increased inflammatory markers, which put individuals at risk for chronic diseases. Mindful meditation not only decreases perceived stress but also has the potential to decrease the risk of chronic diseases and health care cost. Purpose: The purpose of this mindfulness meditation project is to reaffirm that mindfulness meditation decreases perceived stress scores and to determine whether mindfulness meditation decreases health care cost. Theoretical Model: The relation of mindfulness meditation, lowered stress levels, and chronic diseases can be explained by the social cognitive theory (SCT). Applying SCT, meditation’s goal is to alter …

Developing A Guideline Driven Provider-To-Provider Handoff Tool For Heart Failure Patients, Nicole Dellise

DNP Projects

The American Heart Association (AHA) and Heart Failure Society of America’s (HFSA) guideline for Management of Heart Failure in Skilled Nursing Facilities acknowledged poor communication from hospitals to skilled nursing facilities (SNF) as a barrier to optimal heart failure (HF) management. The purpose of this pilot study was to improve adherence to guideline directed HF care in SNFs through enhanced communication between hospital HF specialists and providers at SNFs. The project leader designed a guideline driven provider-to-provider HF handoff tool. Twenty-one patient discharges were evaluated in the study. Follow up phone calls were made to SNF staff nurse within 48 …

Proper Prescribing Of Controlled Drugs: A Pilot Study Of A Web-Based Learning Modules’ Impact On Knowledge, Attitude, And Practice In New Graduate Nurse Practitioners, Shelly Duckett

DNP Projects

Controlled substance abuse is a global epidemic. Several factors that influence health care providers prescribing habits have been presented in recent literature. However, the existing evidence primarily reflects the prescribing habits of physicians, while relatively little is known about the prescribing habits of nurse practitioners. The purpose of this project is to evaluate the impact of a brief web-based continuing education module targeting appropriate prescribing of controlled substances for recent graduate nurse practitioners. The project served to assess the provider’s knowledge, attitude, and practice compared to current integrated curriculum on prescribing and assess change in knowledge. Two online educational modules …

Maternal Monitoring Of Adolescent Type 1 Diabetes Management And Its Influence On Adolescent Quality Of Life And Adolescent Depressive Symptoms, Anna Gorzny

DNP Projects

While current literature identifies variables such as demographics, parental monitoring, and family functioning and their association with glycemic control in adolescents with type 1 diabetes mellitus, there has yet to be sufficient evidence identifying and supporting the relationships between the level of maternal monitoring and adolescent psychological wellbeing. The purpose of this scholarly project was to assess whether higher levels of maternal monitoring of diabetes management practices was associated with fewer adolescent depressive symptoms and higher adolescent quality of life. The study sample consisted of 117 adolescents between the ages of 10 and 16 with type 1 diabetes and their …

Provider Referral Of Patients With Acute Low Back Pain To Physical Therapy: Implications For Outcomes And Costs, Corinne Griggs

DNP Projects

Because most patients with an acute episode of low back pain (LBP) enter the health care system through primary care, it is important primary care providers consider the effects of their decisions on patient outcomes and costs. Although guidelines for primary care management of acute LBP do not place emphasis on physical therapy, they have not been updated since 2007, and more recent evidence supports the use of timely physical therapy in acute LBP patients without “red flags.” Additionally, many studies indicate specialist or surgical consultation is over-utilized, inflating costs and delaying physical therapy. The aim of this project was …

Exploring Affects Of Critical Care Work Environments On Professional Quality Of Life, Marissa Monroe

DNP Projects

Burnout and compassion fatigue among critical care nurses can affect individual patients, healthcare systems, and nurses’ health and wellbeing. Both burnout and compassion fatigue have been well described in the literature as key elements that contribute to a nurse’s overall professional quality of life, and can be directly influenced by the health of the nurses’ work environment. The AACN defined six standards of a healthy work environment, which include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership. The purpose of this project is to explore which of the AACN Healthy Work Environment standards have the …

The Effects Of A Brief Yoga Intervention On Psychologic And Physiologic Measures In Women Recovering From Substance Abuse Disorders, Robi C. Hopp

DNP Projects

Women are the fastest-growing population experiencing substance use disorders (SUDs) in the United States. Multiple barriers e.g., mental health disorders, reduced self-efficacy, lack of social support have been identified and negatively impact acute and sustainable recovery efforts. The aim of this project was to evaluate the effects of yoga on mood status, biometrics, and self-efficacy toward yoga in a cohort at The Next Door, a substance abuse treatment center for women only. This was a quasi-experimental research approach with 14 women completing a total of 8 weekly yoga sessions over a ten-week period. Appropriate demographic data was collected. Measurements were …

Evaluating Adherence To The Sepsis Bundle And The Effectiveness Of Best Practice Alerts, Kate M. Burnett

DNP Projects

PURPOSE: To evaluate the adherence to the CMS sepsis recommendations and sepsis bundle used by the study health system before and after the implementation of Best Practice Alerts (BPAs) and assessing the effect of these alerts on patient outcomes.

METHODS: The study was a single-center, process evaluation through a retrospective chart review within a southwest healthcare system. The sample consisted of 73 patients for the pre-implementation period (May 1, 2016-September 7, 2016) and 75 patients for the post-implementation period (September 8, 2016-April 30, 2017).

RESULTS: No major differences were found between the two groups with regard to patient age, ethnicity, …

Evaluation Of Move Early Mobility Screening Protocol In Non-Surgical Mechanically Ventilated Patients In The Intensive Care Unit, Lauren Johnson

DNP Projects

Objective: To evaluate the effectiveness of a previously implemented, nurse driven early mobility screening protocol, called “MOVE”, during its first 6 months of use.

Methods: A retrospective electronic medical record review was conducted (n=100) at Norton Audubon Hospital in Louisville, KY. Eligible electronic medical records were randomly selected and audited for the following variables: age, sex, ethnicity, admission diagnosis, comorbidities, ventilator days, invasive catheters, utilization of vasoactive or inotropic medications, restraint use, continuous sedation medications, Richmond Agitation Sedation Score (RASS), Confusion Assessment Method for the ICU (CAM-ICU), nurse adherence to charting of MOVE enrollment eligibility, physical …

The Effect Of A Patient And Provider Education Program On Antibiotic Overuse In Respiratory Tract Infections In A Rural Primary Care Population, Erin Chiswell

DNP Projects

Objective: In the “walk-in” portion of the Jessamine Medical and Diagnostic Center (JMC) primary care (PC) practice in Jessamine County, Kentucky, a combination patient and provider education program was implemented to assess its effects on antibiotic prescribing in respiratory tract infections (RTIs). The goal was to conduct an evaluation of the patient and provider education program at JMC, by specifically examining changes in immediate antibiotic prescribing in RTI (i.e., prescription given during visit to start taking immediately) one-year after implementation of the education program (March 1, 2015- February 28, 2016).

Methods: Utilizing a quasi-experimental pretest-posttest design, a retrospective electronic medical …

Assessment Of An Intervention To Improve Clinical Inertia In Patients With Uncontrolled Hypertension In A Primary Care Setting, Alyssa M. Sutton

DNP Projects

Purpose: A quality improvement project was undertaken in an internal medicine clinic to evaluate provider adherence with the Eighth Joint National Committee (JNC 8) hypertension (HTN) medication management guidelines for adult patients diagnosed with HTN, evaluate characteristics associated with clinical inertia (CI) in patients with uncontrolled HTN, and evaluate the utility of a brief educational intervention to decrease CI.

Methods: The project used the plan-do-study-act method to assess JNC 8 prescribing guideline adherence by consenting providers. Medical records were randomly selected from patients with HTN seen at provider visits 10 days before (January 31-February 13, 2017) and 10 days after …

Parent Perception Of Child’S Developmental And Coordination Skills Related To Participation In The Gymnastics Through Early Movement Program, Allison M. Theobald

DNP Projects

This study aims to evaluate the effectiveness of the Gymnastics through Early Movement program in increasing motor ability in children with motor developmental delay or coordination deficits through the perception of the parent. The Gymnastics through Early Movement program is a therapeutic gymnastics program developed by a pediatric nurse and professional member of United States of America Gymnastics. The program was designed specifically for pre-school aged children who experience motor challenges. Over the course of six weeks, each 45-minute lesson included activities and obstacles focusing on fundamental preschool gymnastics skills to develop strength, coordination, and flexibility. The American Academy of …

Assessing Provider Adherence To The 2013 Acc/Aha Hyperlipidemia Guideline, Adrienne Johnston

DNP Projects

Background: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in the United States and accounts for more than 17.3 million deaths per year with hyperlipidemia as one of the leading risk factors. The 2013 American Heart Association/American College of Cardiology (AHA/ACC) hyperlipidemia guideline recommends healthy lifestyle habits, risk estimation of the development of cardiovascular disease using a risk calculator, and intensity dosed statin therapy. There has been controversy among providers resulting in confusion and inconsistent application of the guideline. Purpose: The purpose of this project was to examine provider adherence to the AHA/ACC hyperlipidemia guideline in a primary …

Evaluation Of Kentucky Nurses' Knowledge And Self-Efficacy Related To Safe Sleep And Sudden Unexpected Infant Death Risk-Reduction Strategies, Lisa Mcgee

DNP Projects

Sudden Unexpected Infant Death (SUID) claims the lives of about 3700 infants in the United States each year (CDC, 2015). It is the second leading cause of infant death in Kentucky (KDPH,2015) where it has a rate almost three times that of the nation. The American Academy of Pediatrics (AAP) has made recommendations to decrease the risk of SUID and indicates hospital professionals, including nurses, have a responsibility to educate and model safe sleep strategies for parents. An evaluation of the knowledge and self-efficacy about safe sleep and SUID risk-reduction strategies of neonatal and perinatal nurses in Kentucky birthing and …

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% …

A Process Improvement Project To Increase Diabetic Retinopathy Screening Rates As Evidenced By Formal Documentation, Michelle Renae Campbell

DNP Projects

Purpose: To evaluate the effects of a referral process on diabetic retinopathy screening rates among patients with Type 2 diabetes and formal documentation completion rates of these screenings within a primary care setting.

Methods: A referral process for patient referral to an ophthalmologist for annual diabetic retinopathy screening was instituted for a 4-week period within a Norton Community Medical Associates (NCMA) primary care location for Type 2 diabetes patients. Charts of 30 patients pre-intervention were compared with the charts of 30 patients seen during the intervention phase of the study to evaluate the effects of the referral intervention. Demographic data, …

Introduction Of A Comprehensive Modified Early Warning Scoring System In A Large Rural Hospital, Beth A. Meade

DNP Projects

PURPOSE: To develop and test a comprehensive modified early warning scoring (MEWS) system for use on two medical-surgical-telemetry units in a large rural hospital in northeastern Kentucky; to educate and train nursing staff in utilization of a new MEWS system and early identification and management of clinical deterioration; and to determine nursing satisfaction regarding education, training, and use of a new MEWS system.

BACKGROUND: Adult medical-surgical patients are at risk for clinical deterioration. Rapid response systems and MEWS systems are strategies that have been employed to assist nursing staff in early identification and management of clinical deterioration. Testing of a …