Nursing Commons^™

Fostering Resilience In Children Of United States Navy Seals Using A Social Media Platform, Riley Walker

Doctor of Nursing Practice Final Manuscripts

Background: Having resilience helps children overcome, cope, and manage stressors that they encounter throughout life and provides intrinsically protective factors to help a child thrive in the face of adversity.

Local problem: Children of United States Navy Sea, Air, and Land Operators (SEALs) face consistent stress as their parent is away from home more than 240 days per year doing high-risk training exercises.

Methods: Resilience education to mothers of children whose fathers are United States Navy SEALs delivered virtually on a social media platform. Pre- and post- intervention surveys using the Likert scale were conducted to measure the mothers’ understanding …

Nurse-Led Post Stroke Depression Screening (Psd) For Patients With Acute Stroke Using Patient Health Questionnaire-9 (Phq9), Stefan Panov

Doctor of Nursing Practice Final Manuscripts

Introduction: This Evidence-Based Practice Doctor of Nursing Practice project aimed to implement a nurse-led post-stroke depression (PSD) screening using Patient Health Queastionnaire-9 (PHQ-9) in a 12-bed progressive care neuro-stroke unit at a tertiary care hospital. The first goal of this project was to detect stroke patients at risk for depression who met specific inclusion criteria. The second goal was to provide depression education, initiate social work and medical referrals, and start pharmacological treatment to reduce the medical and socioeconomic burden associated with untreated PSD before discharge from the hospital.

Background: Globally, stroke is a prominent cause of death and disability. …

Church-Based Hypertension Education: An Alternative Solution To Hypertension Management In The African American Community, Nicole Tofi Rice

Doctor of Nursing Practice Final Manuscripts

Purpose: The objective of this evidence-based project is to explore a church-based hypertension education program as an alternative solution to providing hypertension education to the African American community. The desired goals of this project are: (a) to assess the current levels of adherence to antihypertensive therapy among members of a local African American church, using the Hill-Bone Compliance to High Blood Pressure Therapy Scale, and (b) to conduct a literature review exploring policy options encouraging the implementation of a church-based hypertension education program.

Background: Despite medical advances aimed towards prevention and effective treatment, the African American community remains disproportionately affected …

Improving Patient Self-Efficacy, Readiness, And Completion Of Advance Care Planning Documents Using Prepare Documents And Advance Care Planning Group Referral, Marie Vassiliadis

Doctor of Nursing Practice Final Manuscripts

Advance Care Planning (ACP) is an ongoing discussion about medical decision making between a provider, patient, and support person. ACP can also include legal documentation in the form of an advance directive (AD). Nationally, only 36.7% of adults complete any form of AD for end-of-life care. Recently, ACP has become an important quality metric that many organizations are prioritizing. The purpose of this evidence-based project is to improve ACP readiness, self-efficacy, and documentation among patients at an internal medicine clinic using the PREPARE program and referral to an ACP group meeting. PREPARE for Your Care is an online program aimed …

Managing Menopausal Symptoms Through Exercise And Dietary Changes, Ae Rah Kang

Doctor of Nursing Practice Final Manuscripts

Background: The most critical aging stage for women is the menopausal transition period, which causes various symptoms such as hot flashes, night sweats, sleeping disturbance, and mood swings that lower women's quality of life. Menopausal symptoms that are not managed can exacerbate severe medical conditions such as cardiovascular disease, bone illnesses, neurological diseases, and psychosocial problems. As the first non-pharmacological treatment for menopausal syndrome, several studies have shown that regular exercise and diet control can potentially improve menopausal symptoms and the quality of life.

Purpose: This project aimed to examine the effect of improving the quality of life by reducing …

Improving Care For Children And Adolescents With Down Syndrome In The Military Health System, Katherine B. Arrogante

Doctor of Nursing Practice Final Manuscripts

Background: Down syndrome (DS) is the most common chromosomal disorder worldwide. In the United States, DS occurs in one out of every 700 births. Children with DS have an increased risk of developing serious health conditions. In the military health system, children with DS face many barriers such as frequent relocations and poor access to specialty care. Primary care providers (PCPs) do not consistently follow published guidelines for health supervision.

Purpose: This project aims to improve the care for pediatric patients with DS in the military health system by increasing the knowledge and confidence of PCPs.

Methodology: An educational program …

Implementation Of The Columbia-Suicide Severity Rating Scale At An Outpatient Mental Health Practice To Increase Provider Confidence In Identifying Suicide Risk, Lauren Reed

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based Doctor of Nursing Practice project was to implement the Columbia-Suicide Severity Rating Scale (C-SSRS) as part of routine patient assessment at an outpatient mental health practice to increase the likelihood of identifying clients at risk for suicidal behavior and increase provider confidence in screening for suicidal behavior. The study site is a Southern California-based outpatient mental health practice that employs a variety of clinicians, including psychiatric-mental health nurse practitioners, to provide mental health care to clients across the lifespan.

Background: Approximately 57% of individuals who die by suicide had at least one contact with …

Evaluation Of Depression Screening Frequency In The Geriatric Population: A Pilot Project, Neha Bhagat

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to emphasize the importance and address the frequency of depression screenings for patients 65 years and older who reside at a nursing home. The first goal was to conduct a retrospective chart review of 18 patients residing at an assisted living facility (ALF) to determine whether a depression screening was completed two-four weeks after admission. The second goal was to educate ALF staff on evidenced-based practice of the importance and frequency of depression screenings for the elderly. The third goal was to increase ALF staff knowledge …

Implementation Of The Generalized Anxiety Disorder 2-Item Screening Tool For Adult Patients In An Underserved Outpatient Cardiology Clinic, Leila Joint

Doctor of Nursing Practice Final Manuscripts

Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization …

Improving Access To Colorectal Cancer Screening In Latino Communities In California: Eliminating Transition To Practice Hours For Nurse Practitioner Full Practice Authority, June Spilburg

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence based practice Doctor of Nursing Practice (DNP) project was to investigate barriers to colorectal cancer screening in young Latinos living in California. The goals of this project included examining current trends in colorectal cancer in young Latinos, factors which affect access to care, and the current and future state of the California primary health care provider workforce. The aim of this project was to make recommendations regarding strategies to improve access to colorectal cancer screening among Latinos in California.

Background: Early onset colorectal cancer (EO-CRC) is increasing in Latino communities, with colorectal screening rates …

The Future Of Cognitive Dysfunction In Elderly Patients: A Clinical Perspective With Recommendations, Laura Taylor

Doctor of Nursing Practice Final Manuscripts

Background: The U.S. Census Bureau projects the number of Americans age 65 years and older will more than double between 2010 and 2050. The geriatric patient population will likely require the use of surgical services at a higher rate than ever before. To best care for the elderly undergoing procedures with anesthesia, it is imperative to follow the most up to date evidence to avoid post-operative complications, and more specifically post-operative cognitive dysfunction.

Purpose: The purpose of this DNP evidence-based practice project is to identify patients that are at high risk for post-operative cognitive dysfunction prior to undergoing anesthesia. Post-operative …

Feasibility Of Family Focused Obesity Screening In Primary Care, Adrianne Griffiths

Doctor of Nursing Practice Final Manuscripts

Background: Obesity is associated with serious medical conditions including diabetes, hypertension, and heart disease. It also contributes to decreased productivity at work and school, financial strain, and reduced quality of life.

Purpose of Project: To address this problem, a nurse practitioner-led screening and intervention program was piloted at a primary care clinic in southern San Diego. The tool provides a standardized method for screening individuals and their families for nutrition and physical activity deficits associated with obesity, as well as appropriate and effective interventions to prevent and manage obesity.

Methods: The Family Nutrition and Physical Activity (FNPA) screening tool is …

Improve Hypertensive Patients’ Compliance Postgraduation From The Virtual Care Team Program, Marcie Santillan

Doctor of Nursing Practice Final Manuscripts

Background: Virtual Care Team (VCT) began their program approximately 15 months ago to assist their most vulnerable patients with chronic and uncontrolled conditions such as hypertension, diabetes mellitus, and nicotine use disorder. The program follows the patients for a year to help them manage their chronic conditions and comply with chronic management. When the Virtual Care Team followed up a few months after the graduation with some recent graduates, it was found that a small number of patients returned to their pre-Virtual Care Team habits.

EBP Purpose: The purpose of the project is to follow up on those …

Reducing Polypharmacy Amongst Home Based Older Adults Using Patient Centered Education, Evelyn Oluoha

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to identify and implement a patient education program on medication safety that can help reduce instances of polypharmacy among home-based elderly patients. This education program is pursued as an effective intervention in reducing polypharmacy in home-based older adults.

Background: Studies show that the majority of home-based older adults take at least one to five medications daily, increasing the risk of polypharmacy adverse medical outcomes. Effects of polypharmacy include medication non-adherence, increased risk of potentially inappropriate medication, drug-drug interactions, drug duplications, adverse drug reactions, and higher healthcare …

Advocating For Nurse Practitioner Independent Practice, Tamara Troyer Denlinger

Doctor of Nursing Practice Final Manuscripts

This project was an anonymous qualitative/quantitative survey of nurse practitioners in California to determine if passage of AB 890, which provides a pathway to independent practice, will result in more NPs choosing to practice independently after clinical hour requirements are met. Access to primary health care in California is projected to worsen over the next 10-15 years, particularly in rural areas, and an average of 44% of residents may be without enough access to care. Some areas in the state will be harder hit than others with Alpine, Calaveras, Glenn, and San Benito counties likely to be hardest hit by …

Implementation Of A Shared-Decision Making (Sdm) Approach In A Community Based Outpatient Mental Health Clinic, Alexa Vuylsteke

Doctor of Nursing Practice Final Manuscripts

Purposes/Aims: The purpose of this Doctor of Nursing Practice (DNP) project is to implement an evidence-based SDM approach in a culturally diverse community mental health clinic in order to increase patient-provider collaboration and improve patient autonomy and engagement in decision making processes of care in a mental health setting.

Rationale/Background: According to the Substance Abuse and Mental Health Services Administration (SAMHSA), shared decision-making (SDM) is a collaborative communication approach between patient and provider that aims to help people in treatment work together to have informed, meaningful discussions about their health care decisions. SDM is an evidence-based approach to encourage and …

A Pilot Project For Tuberculosis Education In College Students, Sarah Williams

Doctor of Nursing Practice Final Manuscripts

Background: San Diego’s Tuberculosis (TB) incidence is more than double the national rate. The majority of cases of active TB are due to the progression of latent TB infection (LTBI).

Objectives: This evidence-based practice (EBP) project aimed to increase knowledge, awareness, and improve attitudes and practices regarding TB among college students.

Participants: Twenty Community College Students in San Diego participated in the project.

Methods: Students attended an in-person educational session. A pre-post knowledge, attitudes and practices (KAP) questionnaire measured the impact.

Results: The intervention improved knowledge and attitudes. The average post-intervention TB knowledge score was 95.8% compared to 57% …

Exercise As A Prescription For Patients With Depressive Disorders: A Quality Improvement Project, Sydney Roscoe, Rachelle Pace

Doctor of Nursing Practice Final Manuscripts

Purpose: The aim of this Doctor of Nursing Practice project was to increase exercise counseling rates in the treatment of depression by (1) implementing a focused educational training program and (2) understanding factors that impacted utilization of the practice change.

Background: Approximately 280 million individuals suffer globally from depressive disorders. Depression remains the fourth leading cause of disabilities, significantly contributing toward the global burden of disease by increasing morbidity and mortality risk. Psychopharmacology and psychotherapy are current gold standards of treatment; however, providers often overlook the significant role exercise serves in reducing depressive symptoms and severity, as it remains underutilized. …

Measuring The Effectiveness Of Antidepressant Treatment By Implementing Beck's Depression Inventory (Bdi), Azeem Anjum

Doctor of Nursing Practice Final Manuscripts

Purpose: This evidence-based practice project integrates a structured periodic depression evaluation follow-up protocol for patients diagnosed with Major Depressive Disorder who have been prescribed antidepressant(s) at an outpatient mental health clinic. The purpose of this DNP project is to standardize the method of treatment progression monitoring to improve the timeliness of change detection and subsequent treatment adjustments using the Beck Depression Inventory (BDI) Scale.

Background: According to the World Health Organization (WHO), MDD is one of the most common mental health conditions affecting approximately 280 million people globally and 17.5 million adults in the United States. (WHO, 2021). The economic …

Mental Health Wellness In The Latino Population: Improving Phq-9 Scores In Depressed Patients With Comorbid Type Ii Diabetes, Amanda Cuellar

Doctor of Nursing Practice Final Manuscripts

Major depressive disorder is one of the most common mental health conditions. In the United States, 8.1% of the population have symptoms of depression. Patients with diabetes are 2–3 times more likely to experience symptoms of depression compared to the general population. Having these chronic conditions simultaneously can cause complications in both. The purpose of this study was to improve depression scores for patients who have comorbid type II diabetes. This project took place in a rural community with the Latino population. The nurse practitioner led an evidence-based practice project implementing treatment of depression with medication management, individual psychotherapy, and …

Implementation Of An Evidenced Based Peripheral Artery Disease Screening Protocol In An Outpatient Internal Medicine Clinic, Sarah Lee Bolanos

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidenced based project was to implement an evidenced based peripheral artery disease screening protocol in an outpatient internal medicine clinic serving adult patients with multiple co-morbidities. This clinic inconsistently screened patients for PAD using the ankle-brachial index (ABI).

Methods: During a three-month period, 50 patients were screened using current American Heart Association and American College of Cardiology (AHA/ACC) screening guidelines for PAD using the Ankle-Brachial Index (ABI) and the Edinburgh Claudication Questionnaire (ECQ).

Results: Out of the 50 patients screened for PAD, only one patient (2%) had a normal ABI score (1.0-1.4) and was categorized …

Increasing Utilization Of Ivc Pocus For Patients With Sepsis, Alexis Arreola

Doctor of Nursing Practice Final Manuscripts

Background: Sepsis is the cause of death of half of all admissions in the United States (Rhee, 2019). Medicare has adopted guidelines from the surviving sepsis campaign and labeled them the “The Severe Sepsis and Septic Shock Management Bundle (SEP-1) guideline to address the care required to try to reduce mortality involving septic patients. This bundle has an all or none feature that suggests every patient presenting with septic shock receives 30 ml/kg of normal saline as a bolus. (Medicare, 2021). One must document medical reason for not providing this bolus. Inferior vena cava point of care ultrasound (IVC POCUS) …

Implementation Of The American Diabetes Association Pharmacological Approach For Adults With Type 2 Diabetes Mellitus With Cardiovascular Disease, Jose Cedillo

Doctor of Nursing Practice Final Manuscripts

Introduction: The purpose of this evidence-based practice project is to improve the utilization of the 2022 ADA pharmacological approach for individuals with Type 2 Diabetic Mellitus (T2DM). The project implementation site was an outpatient clinic in Southern California with a large T2DM Hispanic population. The new ADA guidelines recommend selecting a glucagon-like peptide 1(GLP-1RA) and/or sodium-glucose cotransporter two inhibitors (SGLT-2) when clinically appropriate to reduce the risk of major cardiovascular events in T2DM patients.

Background: According to the American Diabetes Association, ASCVD is the leading cause of morbidity and mortality for adult individuals with T2DM. The use of …

Be Kind To Your Mind: The Use Of Mobile Based Applications To Reduce Stress And Improve Health Outcomes, Akira Hanson Finn

Doctor of Nursing Practice Final Manuscripts

Now more than ever mental health is in the spotlight on a global scale. Professionals from a variety of different disciplines are being encouraged to evaluate several different coping techniques in order combat the magnitude of societal crisis being discovered post-pandemic. At the top the list is Mindfulness-based interventions. The concept of mindfulness practices is nothing new. Evidence suggests it has existed for thousands of years; however, it is getting more notoriety in the past decade due to increasing expansion of mobile-based applications. These types of technology driven applications offer an easily accessible, convenient, and trackable way for individuals to …

Implementation Of The Diet Readiness Test To Assess Self-Efficacy And Education Effectiveness In Overweight Women, Tatjana Ilich

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based Doctor of Nursing Practice (DNP) project was to assess perceived self-efficacy in overweight women who are participating in a weight loss program and the effectiveness of education being provided using the Diet Readiness Test (DRT).

Background: Obesity is a rapidly growing public health problem affecting an increasing number of countries worldwide because of its prevalence, costs, and health effects. Among women between the ages of 40 and 60, more than 80% report that they are either trying to lose weight or trying to maintain weight. The overall prevalence of obesity was similar among men …

Talking With Horses: Equine Assisted Activities To Promote Social Engagement In Individuals With Autism Spectrum Disorder, Amy Ezhaya

Doctor of Nursing Practice Final Manuscripts

Purpose of Project: The purpose of this evidenced-based project is to gather data on how therapeutic horseback riding (THR) facilitates social engagement in individuals with autism spectrum disorder (ASD). The project aims to provide alternative treatment options and disseminate information to providers on the importance of community partnerships.

Background: In 2020, it was estimated that 1 in 54 children had ASD, which is a 170% increase since 2000. Often, those diagnosed with ASD also experience co-occurring mental health diagnoses placing a large burden of care on our healthcare system. THR is a growing alternative treatment option and has been found …

Improving Nursing Student Retention: Early Identification Of Determinants Causing Attrition In Nursing Academic Programs, Tennille Gifford

Doctor of Nursing Practice Final Manuscripts

Introduction: Student success in higher education is a vital focus for the health of a community and the improvement of an individual’s life. It is equally detrimental if a student leaves an educational program without a degree. The purpose of this project was to improve the early identification of students at risk of attrition in a nursing program by using an electronic dashboard interfaced with a self-reporting student survey to identify determinants that are statistically significant factors for student attrition. Background: The current accreditation benchmark for nursing program completion is 70% for Bachelor of Science in Nursing degrees. Concordia St. …

A Comparison Of Suprathel Burn Dressing Vs Standard Care On Length Of Hospitalization, Pain Scores, Opioid Use, Treatments, And Outcomes., Rakiema T. Sellars-Pompey, Anthonia Okoh

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidenced-based practice Doctor of Nursing Practice (DNP) project was to determine the impact and efficacy of using Suprathel artificial wound and burn dressing on patients treated at a UC San Diego Health Regional Burn Center for second-degree burns. The primary goal of this project will be to evaluate the impact of using Suprathel on hospital length of stay; compare wound infection rates, pain score, and morphine equivalent use; and to identify the cost-effectiveness of the Suprathel artificial wound and burn dressing.

Background: Burns are a global health concern causing significant morbidity and mortality, …

The Impact Of The Family Nutrition And Physical Activity (Fnpa) Tool With Diet And Physical Education On Obesity Awareness And Body Mass Index (Bmi) Of Overweight Patients, Sheena Amos

Doctor of Nursing Practice Final Manuscripts

Purpose

This evidence-based practice project aims to apply the Family Nutrition and Physical Activity (FNPA) tool with diet and physical education to increase obesity awareness and decrease body mass index (BMI) among overweight parents in the community. The FNPA screening tool is a behaviorally based assessment designed to allow parents to evaluate obesogenic environments and practices that may predispose their children to become overweight. The first goal was to recruit parents in the community and utilize the FNPA tool to assess and better understand their diet and physical activity levels. The second goal was to increase obesity awareness among these …

Utilization Of Telemedicine For Follow Up Appointments In Radiation Oncology, Priya Patel

Doctor of Nursing Practice Final Manuscripts

Access to healthcare remains a problem for patients in the United States, especially those who live in remote areas, are immobile, immunocompromised, or are experiencing financial strain. These barriers can lead to missed appointments, putting financial strain on healthcare institutions, and contributing to productivity loss and underutilization of clinic resources. During the COVID-19 pandemic there was a rapid increase in the use telemedicine. Patients were surveyed on the quality of their telemedicine visit at the UCSD Health Moores Cancer Center Radiation Oncology department. The majority of patients would schedule telemedicine appointments in the future, which can reduce the burden on …