Nursing Commons^™

The Effect Of The Screening, Brief Intervention, Referral To Treatment (Sbirt) Model On Adult Depression In An Outpatient Setting, Genevieve E. Sweeney

Doctoral Projects

Depression is one of the most common chronic conditions in the world. Despite this, depression continues to be under-screened, inaccurately assessed and diagnosed, and poorly treated in outpatient settings. Many providers solely rely on clinical judgement instead of a screening tool or evidence-based toolkit when a patient presents with depression symptoms, resulting in underdiagnosis and inappropriate treatment. Utilization of resources can help a provider appropriately screen, diagnose and treat an individual with depression. Screening, Brief Intervention, Referral to Treatment (SBIRT) is an evidence-based model intended to improve these measures. Studies from the literature support the efficacy of the SBIRT model …

Primary Care And Behavioral Health Provider Communication: Strategy For Improvement, Kathleen J. Matthews

Nursing Capstones

Communication in health care is essential. Limited communication between primary care and behavioral health providers was identified as a barrier access to care and effective collaborative care of patients seeking behavioral health treatment in the Matanuska-Susitna (Mat-Su) Borough, Alaska. A one-group pre- and post-test design quality improvement project was created to develop and implement a standardized communication template to facilitate communication and collaboration between behavioral health and primary care providers in the project group. The theory of relational coordination with an emphasis on the mutually reinforcing interaction between relationships and communication served as the theoretical framework for the project. Objectives …

The Effect Of Care Coordination On Hemoglobin A1c For Type 2 Diabetes Patients, Lee Ann Hinsky

Electronic Theses and Dissertations

The purpose of the study was to test the impact of care coordinator visits by primary care registered nurses on serum hemoglobin A1c (HbA1c) levels in patients with type 2 diabetes. In the study, the researcher compared 2 groups of type 2 diabetes patients—those who had care coordinator visits from registered nurses and those who did not—through retrospective data collection and analysis from the patients’ electronic medical record from July 2018 through December 2018. An independent samples t test was used to compare the means of the intervention and control groups’ change in HbA1c levels. The intervention and control groups …

Active Rehabilitation In Sports-Related Concussions: An Educational Intervention For Primary Care Providers, Lior Habinsky

Doctor of Nursing Practice Projects

Background and Review of Literature: Sports-related concussion (SRC) is a form of traumatic brain injury caused by a blow to the head and remains a prevalent issue across the 11-18-year-old age group within the United States. Historically, total physical and cognitive rest has been the preferred method to help individuals recover after suffering a concussion. However, recent data have shown that incorporating active rehabilitation or aerobic exercise therapy as part of acute post-concussion treatment is safe. Further investigation into these methods could provide valuable insight into prognosis as well as promote clinical recovery.

Purposes/Goal: This project involved delivering an educational …

The Effect Of A Sun Damage Simulation Photography App On The Skin-Protective Behavior Intentions Of Women With Children Age 18 Or Younger, James Bowlds

DNP Projects

Abstract

Background: Skin cancer is the most common form of cancer diagnosed in the U.S. annually, despite being a largely preventable disease through the limitation of ultraviolet radiation exposure. Attempts to decrease its incidence have focused on appearance-based interventions. These have been effective at improving sun-protective behaviors among various subpopulations including people of color. Anecdotal observations suggest mothers more frequently utilize sun protection for their children than on themselves.

Purpose: The purpose of this project was to gain an understanding of the sun protection practices and beliefs of Caucasian and African American mothers, to assess the response to an appearance-based …

Millennial Attitudes Toward Telehealth: An Integrative Literature Review, Hannah Gwyneth Y. Tabora

Honors Undergraduate Theses

Purpose: The primary purpose of this research was to explore individuals born in the millennial generation’s likelihood of using telehealth and virtual office visits as a replacement for face to face provider interactions. The secondary purpose was to examine the feasibility and access of treatable conditions and ailments in a virtual environment.

Methods: A literature review exploring millennials and telehealth was performed using various databases with search terms combined to include: ‘millennials*’, ‘telehealth*’, ‘telemed*’, ‘finance*’, ‘primary care*’, ‘healthcare*’, ‘health knowledge*’, ‘literacy*’, ‘education*’, ‘misinformation*’. The data was conformed into tables that synthesized the relationship between the millennial generation and their access …

Medication Reconciliation In An Outpatient Clinical Setting, Tilena Martin

Walden Dissertations and Doctoral Studies

Medication reconciliation is a fundamental step in the delivery of safe care, because if it is not done correctly, it can set the stage for medication errors. Medication reconciliation has been shown to alleviate safety issues that lead to mortality, falls, and adverse drug reactions. The project question examined how in-service training can improve the knowledge of nurse practitioners and medical assistants about medication reconciliation. The project was guided by Knowles’ theory of adult learning and Rosswurm and Larrabee’s health belief model. A 1-hour educational module was prepared, and all participants completed the training prior to a discussion period. Sources …

Homeless Tailored Primary Care And Access To Ongoing Primary Care Services, Jessica J. Stoefen

All Graduate Theses, Dissertations, and Other Capstone Projects

Homelessness is an increasing problem worldwide. The system for providing medical care to individuals experiencing homelessness is currently a patchwork of multiple different agencies. Many individuals do not utilize routine primary care (PC) services, instead present to emergency departments for nonemergent care. A systematic literature review was conducted using Cochrane Database of Systematic Reviews, CINAHL Plus with Full Text, Consumer Health Complete – EBSCOhost, and PsycINFO from 2014-2019 with the exception of Cochrane which was searched from 2009-2019, to evaluate if tailored PC clinics focused on providing PC services with additional supports to homeless individuals were more effective at engaging …

Implementing A Result Notification And Referral System In A Nurse-Led Wellness Center, Christine Bollom

Doctor of Nursing Practice

Cervical and breast cancer screenings reduce the risk of morbidity and mortality for American women. In 2017, about 70% of U.S. women over the age of 21 obtained a Papanicolaou (Pap) test, which screens for cervical cancer. African American women have a cervical cancer screening rate of 74.6% and Hispanic women have a rate of 68.6%. The cervical cancer screening rates decrease to 51% for women who are uninsured (Centers for Disease Control and Prevention, 2017). In the United States, 50% of women older than 40 are current on their screening mammogram. African American women have a screening mammogram rate …

Quality Improvement Initiative To Increase Comprehensive Eye Exams In Patients With Diabetes, Julia Khoury

Doctor of Nursing Practice

Diabetic retinopathy is the most common microvascular complication associated with poorly controlled diabetes. Yet, only 60% of the diabetic population receives an annual eye examination by an eye specialist. Retinal imaging increases surveillance of retinopathy, however, it does not take the place of a comprehensive eye examination by an ophthalmologist or optometrist. The aim of this quality improvement project was to increase comprehensive eye examinations in patients with diabetes aged 18 to 75 years in a family practice that recently purchased a retinal imager. This quality improvement project occurred over a 10-week period. Project objectives included increasing comprehensive dilated eye …

Implementing A Tracking And Referral Follow-Up Process To Increase Screening Colonoscopy Adherence Within A Primary Care Setting, Stephanie Villanueva

Doctor of Nursing Practice

Within the United States, colorectal cancer is the fourth most common cancer diagnosed in both women and men. The American Cancer Society approximated that 97,220 new colon cancer cases and 43,030 rectal cancer cases would occur within 2018. Overall, it was estimated there were approximately 50,630 colorectal cancer deaths in 2018. Despite recommended guidelines, reported screening rates are only 31% to 55%, well below the goal of 75% set by the American Cancer Society. The purpose of this project was to increase preventative colorectal cancer screening referrals and completion of colonoscopies for qualified individuals age 50–75 years within a family …

Genetic Screening For Breast Cancer In The Primary Care Setting, Michael Nick Gomez

Doctor of Nursing Practice

The purpose of this project was to increase adherence to the U.S. Preventive Services Task Force and National Comprehensive Cancer Network guidelines for breast cancer screening and genetic testing. Screening for breast cancer risk factors including genetic testing helps reduce the incidence of breast cancer. A protocol was developed based on national clinical guidelines to increase screening and genetic testing for breast cancer. Provider responsibilities included screening all patients 18 years of age and older for risks factors of breast cancer, referring patients with a significant risk based on the screening for genetic testing and providing referrals for genetic counseling …

Refugees' Perceptions Of Primary Care: What Makes A Good Doctor's Visit?, Anne Mutitu, Bev Zabler, Jeana M. Holt

Patient Experience Journal

Redesigning primary care is a national priority, as the United States (US) struggles with issues of poor access, high cost, and suboptimal quality. Refugees are among the populations who suffer from America’s disjointed health care system, resulting in disproportionate health disparities. Although there are many studies on refugee health, few share refugees' perceptions of primary care. We asked local refugees who were seen for primary care services at a midwestern academic nurse-led clinic, what makes a good doctor's visit?  The clinic served as the hub of a federally funded refugee Community Centered Health Home (CCHH) pilot project. This qualitative study …

Implementing Foot Care Program In A Rural Clinic, Maliheh Bakhshi

Doctor of Nursing Practice (DNP) Projects

Abstract

The prevalence of type 2 diabetes mellitus and its complications have increased in the United States (U.S.) in recent years. Patients with diabetes have a higher risk of foot ulcers due to diabetic peripheral arterial disease accelerated by the direct damage to the nerve and blood vessels in lower extremities by high blood sugar. Foot amputations, and frequent hospital admissions due to these and other diabetes complications are also increasing. Healthcare providers’ have a unique opportunity to prevent these complications and hospital admissions, and to promote patient wellness and physical well-being through the provision of timely education and direct …

The Use Of Simulation To Practice Pre-Exposure Prophylaxis Sexual Health Risk Screening, Management, And Follow-Up Within A Doctor Of Nursing Practice Program., Skyler K. Frye

Doctor of Nursing Practice Papers

Introduction: Incidence and prevalence for human immunodeficiency virus (HIV) has yet to experience a significant decline. Increasing provider knowledge regarding use of Pre-Exposure Prophylaxis, an HIV prevention drug, correlates with increased provider risk screening & prescribing PrEP. Standardized patient (SP) simulation is an effective teaching method for healthcare students to increase knowledge and confidence in providing sexual healthcare.

Purpose: The purpose of this project was to evaluate an educational program aimed at increasing participant knowledge attainment and self-confidence in the ability to ascertain a sexual health history and advance the participant’s ability to manage PrEP candidates in a primary …

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

The Paediatric Nurse Practitioner: The Evolution Of A Role, Velerie Kiers, Caitlyn Shea, Elissa Ladd Dr

Manipal Journal of Nursing and Health Sciences

The paediatric nurse practitioner (PNP) is an advanced practice nursing role aimed at providing high quality care to children of all ages. Paediatric nurse practitioners are credentialed to provide a wide range of services dependent on their role as a paediatric nurse practitioner, i.e. primary care, acute care or neonatal. There are two possible paths that can be taken to become a paediatric nurse practitioner: the traditional path or apply for direct entry nursing program after completing Bachelor’s degree. This article describes the path to paediatric nurse practitioner practice.

The Effect Of Home Blood Pressure Monitoring And Self-Titration On Achieving Blood Pressure Targets, Katina A. Varner

Evidence-Based Practice Project Reports

One-third of U.S. adults over the age of 20 are hypertensive, with an estimated cost of $47.5 billion in direct medical expenses and increased individual CVD risk (CDC, 2018). Routine office visits afford primary care providers a means of managing hypertension; however, time constraints limit the ability to accurately assess and track BP in most patients (Jung, 2015). The purpose of this project was to determine if implementation of HBPM and an algorithm for selftitration of antihypertensive medications increased the number of participants at guideline recommended BP goal over a 90-day period. The Health Promotion Model provided the theoretical framework …

Clinical Practice Guideline Adherence: Primary Prevention Of Cardiovascular Disease In At-Risk Adults, Sharnita L. Rice

Evidence-Based Practice Project Reports

The American College of Cardiology (ACC) and the American Heart Association (AHA) (2013; 2016), as well as the American Diabetes Association (ADA) joined forces to create clinical practice guidelines (CPGs) recommendations for healthcare providers (HCPs) to follow with the aim of preventing cardiovascular disease (CVD). Cardiovascular disease is the leading cause of morbidity and mortality in the United States. The Centers for Disease Control (2017a) estimates CVD costs 325 billion dollars annually. Although CVD has an astronomical cost associated with it, CPG adherence continues to be an issue among HCPs and improvement is warranted. The purpose of this EBP project …

Incorporating Oral Health Care In Pediatric Primary Care Practice, Salamatu Yusif

Evidence-Based Practice Project Reports

The most common chronic disease in childhood is dental caries and is more prevalent than asthma and hay fever (HHS, 2000). Data show that in the United States from 2011-2014, 24% of children aged 2-5 years had experienced dental caries in their primary teeth, with 11% having untreated caries (Dye et al., 2017). Primary care clinicians have an important role to play in promoting children’s oral health as much as dentists because they have more contact with children. The purpose of this evidence-based practice project was to integrate an evidence-based oral health program for children in a pediatric primary care …

Implementation Of An Advance Care Planning Protocol To Increase Advance Directive Completion Rates, Christine Engle

Evidence-Based Practice Project Reports

Advanced directives (AD) allow an individual to retain autonomy in end-of-life decisions and can prevent unnecessary costs and treatments associated with aggressive life-prolonging measures. As of 2017, only an estimated 36.7% of the United States adult population had a form of advance directive documented (Yadav et al., 2017). The purpose of this evidence-based project was to determine if implementation of an advanced care planning (ACP) protocol would increase ACP discussions, AD completion, and result in a modification in stage of change or behavior. The Transtheoretical Model (TTM) and Stetler Model of evidence-based practice were used as the framework to guide …

Depression Screening In The Primary Care Setting, Colleen Dostal, Stephanie Boerding

Doctor of Nursing Practice Projects

Recent data reveals that approximately 17.3 million adults in the US population experience an episode of depression each year. Unidentified and untreated depression has many consequences leading to a poor quality of life, direct and indirect healthcare cost-related increases, and an increase in medical comorbidities. The U.S. Preventative Services Task Force recommends that all adults be screened for depression. The PHQ-2 and PHQ-9 are the most widely accepted screening tools in the preliminary detection of depression. The purpose of this project was to educate health care professionals regarding depression and the implementation of a new depression screening protocol: A positive …

Clinical Guideline Based Interventions To Increase Smoking Cessation Success In Primary Care, Chloe Marth

Doctor of Nursing Practice Projects

Current evidence indicates that providers play an integral role and are most successful in improving cigarette smoking cessation rates through a combination of counseling, patient follow up, and pharmacotherapy. In order to address high smoking rates among patients at a primary care clinic in an urban community, the Five A’s model for smoking cessation (Ask, Advise, Assess, Assist, and Arrange) was initiated. During clinic visits, patients were asked about their smoking status. For those who stated they smoked cigarettes, further evaluation was conducted using the Fagerstrom Test for Nicotine Dependence and the patient’s willingness to quit was assessed. Five of …

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

Doctor of Nursing Practice (DNP) Translational and Clinical Research Projects

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 …

Perceptions Of Adult Patients Accessing Telehealth In An Urban Medical Group, Katharine Shepherd West

Doctoral Projects

Problem: Although implementation of in-patient electronic healthcare records is nearly complete in the United States, this achievement has not translated into consumer-to-business telehealth in the primary care setting. Because there are few studies that describe how and why patients select telehealth, the aim of this study was to learn about perceptions of adult patients in an urban setting when telehealth options are available. Research questions included a) How do patients select any type of appointment? b) How do patients perceive and use telehealth options? c) How and when might telehealth be useful in the future?

Methods: A qualitative study design …

A Retrospective Chart Review Pilot Study Of Fall Prevention Through A New And Innovative Care Model, Lydia Smith

Doctoral Projects

According to the Centers for Disease Control and Prevention (CDC), falls are the leading cause of injury-related mortality in the geriatric population, and they are the most common cause of brain injury and hip fracture. The prevalence for falls is 30% in patients over 65 in the United States who experience a fall annually, and the prevalence in dementia patients can be up to 80% annually; the consequences of falls can include injury, reduction in mobility, depression and decreased socialization with peers (CDC, 2015). The purpose of this retrospective chart review pilot study is to examine the number of falls …

Development Of A Breast Cancer Survivorship Care Toolkit, Lauren Elaine Scott

UNLV Theses, Dissertations, Professional Papers, and Capstones

A breast cancer survivor’s journey does not end with treatment. After treatment, most breast cancer survivors go on to face many life-long physical and mental challenges caused by their cancer and treatment. Once active cancer treatment is completed, patients enter the next important step in cancer care, cancer survivorship. Cancer survivorship is a comprehensive approach to post-oncology management that promotes the best outcomes for survivors as they transition from oncology care to primary care; and new breast-cancer survivorship guidelines have emerged. Research suggests that primary care NPs’ lack of awareness of the current 2016 American Cancer Society/American Society of Clinical …

The Effects Of Implementing A Smartphone Application To Improve Asthma Self-Management In Adults, Lindsay J. Humpfer

Evidence-Based Practice Project Reports

Asthma is one of the most common chronic diseases, affecting 20.4 million adults in the United States (CDC, 2018). While asthma can generally be controlled, patients having an exacerbation may experience missed days of work and school, limitations in daily activities, decreased enjoyment of life, and decreased productivity at home, work, and school (MarcanoBelisario et al., 2013). Therefore, the purpose of this project was to improve patients’ overall asthma control and asthma-related quality of life by encouraging self-management through patient education and the implementation of a mobile smartphone application. A total of 26 adult primary care patients with asthma participated …

Effects Of An Obstructive Sleep Apnea Screening Program On Providers' Adherence, Kelsie A. Tokarczyk

Evidence-Based Practice Project Reports

Obstructive sleep apnea (OSA) is a widely prevalent chronic disease estimated to affect 22 million Americans, with 80 percent of moderate to severe cases undiagnosed (American Sleep Apnea Association [ASAA], 2017). Unmanaged OSA has been associated with numerous detrimental health outcomes including hypertension, chronic heart failure, atrial fibrillation, stroke, and other cardiovascular conditions (ASAA, 2017). The purpose of this evidence-based practice project was to determine if the implementation of a screening protocol would affect providers’ adherence to screening for OSA. The Theory of Planned Change was used as a guide to optimize providers’ adherence to the protocol at a family …