Nursing Commons^™

A Quality Improvement Project To Enhance Self-Management Support For Patients With Type 2 Diabetes Mellitus, Tanya M. Guerrero

Cohort IX

Type 2 diabetes mellitus poses a significant global healthcare threat due to multiple and often life-threatening complications. More than 10.5% of the population in the United States has type 2 diabetes mellitus, with the rate in El Paso, Texas, markedly higher at 15.3%. A 10-day reflective practice showed that patients with type 2 diabetes mellitus often experience uncontrolled hemoglobin A1c levels and high serum blood glucose levels. A review of the literature, in addition to information from the American Diabetes Association, the American Heart Association, and the Centers for Disease Control and Prevention, demonstrated that the use of self-management support …

Assessing The Perceptions And Attitudes Of Burnout Syndrome In Nurse Practitioners In Primary Care Settings, Keisha D. Mckinsey

Electronic Theses and Dissertations

The implications of workload and personal and patient-related burnout have been identified in numerous physicians’ studies. While burnout syndrome has become a subject of great interest for examining provider burnout to assess successful solutions, there is minimal research unique to nurse practitioners in primary care settings. This project was intended to determine the prevalence and effect of nurse practitioners’ burnout in primary care settings and make recommendations for improving nurse practitioners’ overall health and well-being. The key outcomes of concern for this project were, first, improvement in burnout scores on the Copenhagen Burnout Inventory tool pre- and posteducational intervention, and …

The Use Of Automated Text Messaging As An Intervention For Smoking Cessation, Oluwasayo Sinkaiye

Evidence-Based Practice Project Reports

Tobacco smoking is a widespread problem that affects the adult population in the United States (U.S.). In 2018, about 14 of every 100 adults in the USA aged 18 years or older were cigarette smokers (Centers for Disease Control and Prevention [CDC], 2020). Tobacco smoking is associated with chronic disease conditions that have serious health implications including cancer, heart disease, diabetes, and chronic obstructive pulmonary disease (COPD) (CDC, 2020). The purpose of this evidence-based practice project (EBP) was to determine the effectiveness of an automated text messaging application (SmokefreeTXT) for smoking cessation in a primary care setting for adult cigarette …

Pediatric Obesity: Prevention, Assessment And Treatment In Primary Care, Susan Johnson

Theses and Graduate Projects

People of all ages deserve care for the disease of obesity. Pediatric obesity affects one in three children in the United States, and the number of obese children has tripled since the 1970s (Centers for Disease Control and Prevention (CDC), 2018a). High blood pressure, high cholesterol, type 2 diabetes, and sleep apnea are complications that pediatric patients now face, and these diseases are well known to worsen quality of, and potentially shorten life. This scholarly project addresses the question: How can family nurse practitioners effectively address pediatric obesity in the primary care setting? Interventions early in life, perhaps even pre-conception, …

Improving Family Nurse Practitioners’ Knowledge Of Palliative Care Resources, Michelle L. Bond

Theses and Graduate Projects

The shift in healthcare indicates Americans are living longer with progressive chronic illnesses subsequently reducing quality-of-life. Primary care providers have opportunities to assess the need for and implement palliative care to offer holistic symptom management to improve patient’s quality-of-life. The purpose of this scholarly project, guided by Jean Watson’s Theory of Human Caring, is to assess primary care providers knowledge and comfort regarding initiating palliative care while determining if additional education improves their familiarity. The objectives were to review current palliative care literature identifying barriers and inadequacies, determine evidence-based practice to develop an educational presentation and resources to improve communication, …

The Future Of American Primary Care, Julianne M. Johnsonwall

Classical Conversations

Historically, primary care has been delivered by physicians in private practices. However, pre-medical and medical students considering primary care should consider that market trends and physician preferences are changing the delivery methods of primary care. This thesis aims to predict the future delivery methods of primary care in America. By analyzing current studies, articles, and physician polls, it asserts that private practices are not a financially viable practice model and that medical systems will dominate primary care. Firstly, it identifies low insurance reimbursement rates, increasing quality documentation requirements, and an unhealthy work-life balance as the primary obstacles to private practice …

Smoking Cessation Interventions In South Asian Countries: Protocol For Scoping Review, Sajid Iqbal, Rubina Barolia, Laila Ladak, Pammla Petrucka

School of Nursing & Midwifery

Introduction: Unfortunately, like many other health risks, smoking rate has been on the rise in developing countries. Half of current smokers in the world reside in only three countries of Asia that include India. Many smoking cessation interventions that were developed and successfully implemented in the context of developed countries have not been equally successful in South Asia. Hence, there is a dire need of culturally relevant smoking cessation interventions. We propose a scoping review with objectives to explore the extent and nature of interventions for smoking cessation and its associated factors in South Asian Region by systematically reviewing the …

A Watched Pot Never Boils: Attentive Care Needs No Timer, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this issue introduction, the editor-in-chief of Journal of Patient-Centered Research and Reviews comments on the premise that length of patient consultation time is less important than what patients perceive happened during that time. Regardless of the time allotted to a clinical visit, health care providers should make efforts to address the emotional and psychosocial needs of their patients. As always, taking a little time to express empathy can make a big difference in patient satisfaction.

Pediatric Caregiver Health Literacy: Comparing Perceptions Of Pediatricians And Nurse Practitioners, Kirbey Flora

Mahurin Honors College Capstone Experience/Thesis Projects

Throughout life, most people will interact with the healthcare system to manage information in order to make healthcare decisions. Health literacy is the ability to comprehend health information needed to make healthcare decisions. Pediatric patients often do not have a voice in their healthcare decisions; therefore, their health outcomes may be affected by the health literacy of their caregivers. In addition, the child’s health may be impacted by the ability of the healthcare team to provide appropriate health education. The purpose of this honors thesis was to determine pediatric healthcare providers’ perception of health literacy in their practices. Qualitative data …

Confidence, Interest And Intentions Of Final-Year Nursing Students Regarding Employment In General Practice, Kaara Ray B. Calma, Susan Mcinnes, Elizabeth Halcomb, Anna Williams, Marijka Batterham

Nursing Papers and Journal Articles

Background: Rising health care burden has increased demand for general practice nurses. Exploring final-year nursing students’ perceived levels of confidence, interest and intention to work in this area can inform preparation and recruitment of new graduates into this workforce.

Aim: To explore final-year nursing students’ confidence, interest and intention to work in general practice.

Methods: Final-year nursing students from five universities situated in New South Wales, Australia were surveyed between March and June 2019. The survey comprised investigator-developed questions and validated tools adapted for use in general practice.

Findings: Of the 355 included responses, 34.1% respondents had a clinical placement …

Using A Psychopharmacology Education Program To Increase Primary Care Provider Comfort With Treating Basic Psychiatric Disorders, Latesha Reed

DNP Scholarly Projects

BACKGROUND: Almost 1 in 5 people have been diagnosed with a mental health illness but the supply of psychiatric providers does not meet patient’s needs. Multiple reasons contribute to this shortage and nurse practitioners are part of the solution. Even with nurse practitioners specializing in psychiatric mental health there is still a shortage. Primary care is where most patients first present their mental health issues.

METHODS: Literature review informed the development of the educational intervention presented to the primary care providers using a digital, asynchronous learning format. A gap analysis of organizational needs and weaknesses was used to determine the …

Improving Tobacco Cessation Counseling Documentation In The Primary Care Setting, Brittany Roher

DNP Projects

BACKGROUND: Tobacco cessation counseling and documentation of the counseling is insufficient in many primary care settings across the United States. This can lead to care gaps such as missed opportunities for interventions appropriate to the level of readiness for change with regard to tobacco cessation. In addition, there is a potential for loss of revenue due to missed opportunities to provide a service and/or not capturing the service when provided. The Medicare Access and CHIP Reauthorization Act (MACRA) in 2015 started a new payment approach known as the merit-based incentive payment system (MIPS) which identified tobacco screening and cessation …

Developing A Clinical Practice Guideline For Colorectal Cancer Screening In Primary Care, Michelle Janise Berkley-Brown

Walden Dissertations and Doctoral Studies

Colorectal cancer (CRC) is the second leading cause of cancer deaths in the United States for both men and women combined. CRC screening is an effective way to reduce mortality and morbidity related to the disease. Practitioners within primary care practices can play an essential role in encouraging people to be screened. Yet, CRC screening rates remain low in primary care practices. Evidence-based strategies are available to help practitioners improve CRC screening activities and improve screening rates. The lack of a clinical practice guideline (CPG) with strategies to help improve CRC screening interventions was identified as a practice gap for …

Collaborating With Rural Practice Partners To Address The Need For Registered Nurses In Primary Care, Robin Brown, Heidi Mennenga, Alham Abuatiq, Linda Burdette, Christiana Plemmons

College of Nursing Faculty Publications

Purpose: Primary care in rural areas of the U.S. urgently need competent healthcare providers, especially registered nurses (RNs). Registered nurses are ideal team members to help meet the primary care needs in rural communities, yet RNs are underutilized in primary care settings and rarely practice to the full scope of their license in these settings. The purpose of the project was to conduct a needs assessment with rural primary care practice partners to address the need for RNs in primary care.
Sample: A needs assessment was sent to nurse leaders at 13 rural primary care facilities via an online survey …

Increasing Adherence To Measurement-Based Depression Management In Primary Care, Renad Saadat

Doctor of Nursing Practice

Background and Review of Literature. Approximately 11 million Americans 18 years or older experienced a severe symptom of depression leading to impairment in 2017. The severity of depressive symptoms is often miscalculated in primary care as measurement-based tools for the diagnosis and ongoing reassessment varies. Purpose. The purpose of the project was to increase provider adherence in using the patient health questionnaire-9 (PHQ-9) for ongoing evaluation of the severity of depressive symptoms in patients with depression at a primary care clinic in San Antonio, Texas. Objectives. The main objective of this Doctor of Nursing Practice project is …

Effect Of An Intervention To Improve Smoking Cessation Treatment In A Federally Qualified Healthcare Clinic, Shirley A. Camp

The Corinthian

Abstract

Significant progress has been made in the reduction of tobacco use in the United States, but the smoking prevalence among the socially and economically disadvantaged populations (i.e. individuals who are homeless, uninsured, LGBT, and living with HIV) is significantly higher than the general population (CDC, 2018b). As a result, these vulnerable populations carry a disproportionate burden of tobacco-related mortality and morbidity (CDC, 2018b). There is a cost-effective and evidence-based treatment for tobacco use dependence (Fiore et al, 2008), but the delivery by primary care providers to this population is inconsistent (Tyman, Bonevski, Paul, & Bryant, 2014). This study focused …

Improvement In Primary Care Identification Of Trauma Symptoms Of Foster Care Children, Crystal Lucas

Dissertations

Introduction: Exposure to adverse childhood events (ACEs) is common in foster children. Primary care providers are ideally positioned to advocate for foster care children through early identification and treatment of trauma-related symptoms and diagnoses during routine well-child assessments.

Purpose: This quality improvement project sought to institute a standardized trauma assessment instrument, the Childhood Behavioral Checklist (CBCL), to determine if there was an increase in the identification of trauma-related symptoms and diagnoses along with an increase in the rate of referral to mental health care (MHC).

Method: This quality improvement project used a descriptive, observational design to complete retrospective and prospective …

Alcohol Misuse And Abuse Among College Students: An Implementation Of A Screening Program., Tiffany Slaughter Newcomb

Doctor of Nursing Practice Papers

Excessive alcohol use in the United States creates serious economic, health, and mortality problems (CountyHealthRankings, 2018). College students experience high rates of use, binge drinking, and 20% of college students meet the criteria for alcohol use disorder [AUD] (NIH, 2014). Screening by healthcare providers (HCPs) in the student health setting is critical and a recommended strategy for reducing negative consequences of alcohol use experienced by college students (US Preventive Services Task Force, 2018).

Aims: The objective of this project was to implement an alcohol screening program among college-age undergraduate students in a university student health center.

Methods: HCPs …

Patient Knowledge And Perception Regarding Antibiotic Misuse In Primary Care, Aimee Cockerham, Megan Mcdaniel, Hannah Mcmillin, Kelly Nash, April Robinson

MSN Research Projects

The Centers for Disease Control (CDC) and Prevention’s 2019 Antibiotic Resistant Threats Report shows that antibiotic-resistant bacteria and fungi cause more than 2.8 million infections and 35,000 deaths in the United States each year. This equates to at least one infection every 11 seconds and one death resulting from antibiotic resistance every 15 minutes. The CDC states that there were almost twice as many deaths each year from antibiotic resistance compared to statistics reported in 2013 (CDC, 2019a). Proper antibiotic use is the responsibility of the provider and the patient. Patient knowledge should consist of how to prevent antibiotic misuse, …

Defining And Characterizing Frequent Attenders: Systematic Literature Review And Recommendations, Dip Shukla, Erik Faber, Brian Sick

Journal of Patient-Centered Research and Reviews

Purpose: To decrease cost and improve efficiency, health care organizations have focused on frequent attenders — patients with high health care utilization. Prior studies have investigated singular health care settings, used varying definitions of frequent attendance, and inconsistently identified factors correlated with frequent attendance. The purpose of this article is to suggest a uniform definition of frequent attenders for different health care settings and to determine factors correlated with frequent attendance.

Methods: This systematic review of three databases identified 2761 unique articles; 174 met inclusion criteria. Studies were analyzed for their definition of frequent attenders and factors associated with frequent …

Solutions To Address Frequent Hospital Attendance, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

In this editorial, practical solutions and considerations in helping the most complex and at-risk patients in our health systems are discussed. These patients, sometimes referred to as health care “super-utilizers” in the literature, tend to be frequently seen and cared for in costly hospital and emergency department settings. Innovative care models that aim to bridge system gaps, achieve better health outcomes, and improve the well-being of both patients and providers are needed and should continue to be explored.

Improving The Rates Of Smoking History Documentation In The Electronic Medical Record., Megan Mccleese Vitellaro

Doctor of Nursing Practice Papers

Lung cancer is the leading cause of cancer related deaths in the United States, and Kentucky leads the nation in lung cancer deaths. Lung cancer care also contributes billions of dollars a year to the cost of health care in this country. The U.S. Preventive Services Task Force (USPSTF) recommends low-dose computed tomography (LDCT) for lung cancer screening with a grade B recommendation, which is a covered service under the Centers for Medicare and Medicaid Services (CMS) guidelines. In order to qualify, patients must have an appropriately documented smoking history. A primary care office was identified within a major healthcare …

Implementation Of The Edinburgh Postnatal Depression Scale In A Midwest Primary Care Clinic, Amanda Lee

Doctor of Nursing Practice Projects

Recent data from the World Health Organization reveals that the prevalence of postpartum depression is about 13%. Research portrays that untreated postpartum depression can have a detrimental impact on maternal and child outcomes. The American Academy of Pediatrics recommends integrating postpartum depression screening at the 1-, 2-, 4-, and 6-month well-child visits. The purpose of this project was to increase early identification of women with postpartum depression (PPD) by increasing the frequency of the Edinburgh Postpartum Depression Scale (EPDS) and evaluating the adherence of the recommended protocol at a Midwestern Primary Care clinic. The healthcare staff received training that included …

Chlamydia And Gonorrhea Health Care Initiative, Brenda S. Nuñez

Cohort VIII

Chlamydial and gonococcal infections are common sexually transmitted diseases (STD) which are increasing each year in the 15-24 years age group. The quality improvement (QI) project aimed to meet clinical guideline recommendations and improve STD screening in this specific age group. The inclusion criteria for this QI project were: asymptomatic sexually active adolescents aged 15-19 years who were tested for chlamydia and gonorrhea during their wellexam visit. The exclusion criteria were pregnancy, patients with recent history of STD, and those undergoing treatment for STD. The Johns Hopkins Nursing Evidence Based Practice Model was used to facilitate the translation of evidence-based …

A Multicomponent Tailored Intervention Program Protocol For Weight Loss In An Underserved Adult Patient Population With Obesity, Rita R. Arnold

Evidence-Based Practice Project Reports

Obesity is a multifactorial, individualized, chronic disease that increases known risk factors for significant comorbidities and mortality. The primary purpose of this Evidence-Based practice project was to improve indicators of obesity (weight, BMI) among patients served by a free medical clinic, using a tailored multicomponent intervention. The secondary purpose was to determine if the weight loss intervention was associated with a decrease in blood pressure and depression symptoms. The intervention was guided by the Health Promotion Model by Nola Pender. The Johns Hopkins Nursing Evidence Based Practice Model (JHNEBP) guided implementation of the project. A comprehensive literature review was completed …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong

Evidence-Based Practice Project Reports

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …

Increasing Chlamydia Trachomatis And Neisseria Gonorrhea Screening Among Women 15 To 24 Years Old Using A Multifaceted Approach, Mackenzie Shireman

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC) (2017a) estimates that one-quarter of sexually active people are between 15 and 24 years old, but account for half of 20 million sexually transmitted diseases (STD) reported annually in the United States. Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) are the most common reportable STDs (CDC, 2018). The purpose of this project was to increase CT/NG screening rates among sexually active, nonpregnant women 15 to 24 years old within the primary care setting through colleague education, routine sexual history taking, and indicated testing. A 30-minute colleague in-service was provided to educate clinical …

Creating Opportunities For Personal Empowerment: A Project Evaluation, Ann L. Cudney

Doctoral Projects

Introduction: 66% of individuals in the United States who experienced a major depressive episode in the last year saw a general practitioner or family doctor and not a psychiatrist or psychotherapist (Center for Behavioral Health Statistics and Quality, 2018). Many primary care providers treat with medication, however, a combination of medication and psychotherapy is associated with better results (Anxiety and Depression Association of America, n.d.). A Midwestern faith-based healthcare organization implemented a pilot cognitive behavioral therapy program at a family medicine residency clinic to improve mental health care.

Objectives: The purpose of this project was to evaluate if the implementation …