Nursing Commons^™

Increasing Healthcare Providers’ Documentation Of Advance Directives In A Primary Care Setting, Ashley Wellman

DNP Projects

Background: Advance directives (ADs) are a proactive, patient-centered tool to facilitate communication about end-of-life wishes between patients, family members, and healthcare providers. Increased importance on ADs is now emphasized in primary care settings; however, findings from recent studies indicate poor documentation of AD discussions or decisions in primary care.

Purpose: To assess current AD documentation practices in an internal medicine primary care department and to explore provider perceptions of facilitators and barriers for discussion and documentation of end-of-life preferences.

Methods: This descriptive study was conducted in three phases: 1) assessment of current state of AD documentation by retrospective chart review …

Implementation Of An Evidence-Based Educational Workshop And Toolkit: Menopausal Women's Healthcare Needs For The Primary Care Provider, Pamela Doerr-Kashani Dnp, Rn

Doctor of Nursing Practice (DNP) Projects

This evidence-based change of practice project involved the development of an educational workshop for primary care providers (PCPs). The intent of the project was to improve PCP’s knowledge of menopausal health, and to create their comfort level when discussing menopausal healthcare with clients. The workshop Menopausal Women’s Healthcare Needs for the Primary Care Provider (Doerr-Kashani, 2014) was created in response to an identified gap in knowledge among PCPs nationally on menopause-related health issues. The workshop was designed as a resource to support PCPs to competently address women’s menopause-related health issues, and enable them to provide comprehensive, evidence-based care within the …

The Effect Of An Educational Intervention On Oral Anticoagulation Therapy Knowledge In Primary Care, Elizabeth D. Deck

Evidence-Based Practice Project Reports

It is estimated that three million people in the United States are on oral anticoagulation therapy (warfarin). Populations studied have been found in therapeutic range 64% of the time (Pernod, Labarere, & Bosson, 2008). The low percentage of therapeutic range is attributable to (a) adherence, (b) monitoring infrequency, (c) Vitamin K antagonists, and (d) the effects of aging and comorbidities. The purpose of this evidence-based practice (EBP) project was to examine whether an educational intervention would improve the knowledge of patients receiving warfarin therapy. Roy’s model for patient adaptation and the Stetler Model for EBP were used as frameworks for …

The Voices Of The People: Lower Sioux Indian Community Members Speak Out On What They Need And Want In A Primary Health Care Clinic On The Reservation, Darin Michael Prescott

UNLV Theses, Dissertations, Professional Papers, and Capstones

American Indian/Alaska Native (AI/AN) people who live on reservations or in urban areas typically receive their health care in clinics that are operated by their tribe or are affiliated with Indian Health Service (IHS), a federal agency that provides care to AI/AN people. The Lower Sioux Indian Community (LSIC) is a federally recognized tribe located in southwest Minnesota near Morton, MN. LSIC members currently receive health care from outside providers at various locations near the reservation. The outsourced services include primary care, emergency care, hospitalization, surgery, dentistry, and podiatry. Because the providers are independent groups and do not work for …

Implementation Of An Advance Directive Protocol In A Primary Care Setting, Gloria Dillman

Evidence-Based Practice Project Reports

Despite the passage of the Patient Self-Determination Act in 1992, only 15% of the United States population has completed an advance directive (AD). This statistic will be exaggerated with the future growth of older adults in the year 2030, at which time this portion of the population is expected to double to 72.1 million people. Without an AD, patients lose their autonomy and may be subjected to costly, life prolonging treatments that they would never choose for themselves. The unnecessary costs and unwanted treatment are preventable with an AD, and primary care providers are in a prime position to initiate …

Examining The Effectiveness Of An Intervention To Increase Provider Assessment Of Overweight And Obesity In The Primary Care Setting, Kristena R. Lea

DNP Projects

Obesity is an epidemic among adults in the United States, leading to a multitude of co-morbidities and billions of dollars in annual healthcare expenditures. Although primary care is the ideal setting for identification and treatment of overweight/obesity, it is often overlooked by providers. This capstone project was formed by three manuscripts, which were written to explore the lack of overweight/obesity identification and treatment in the primary care setting. Emphasis was made throughout the three manuscripts on the importance of providers using body mass index (BMI) as an objective means to discuss overweight/obesity with patients. The first manuscript is an integrative …

Dnp Practice Inquiry Project Report: Depression Screening In Primary Care, Mary Kathleen Stafford

DNP Projects

Depression affects many people worldwide and is a leading cause of disability. National guidelines and recommendations have been created that support screening for depression in the primary care setting, however due to many barriers depression screening is often not performed or documented. This capstone project consists of three manuscripts, which evaluate the lack of depression screening in the primary care setting. The first manuscript is an integrative review of the literature to support depression screening in primary care and to address barriers to depression screening. The second manuscript is a guideline analysis of a national guideline published by the Institute …

Implementation Of Sleep Problem Screening In A Pediatric Primary Care Office, Jennifer Erin O'Donnell

Dissertations

Sleep problems, a major problem for children and their parents, are the most common complaint brought to pediatric clinicians (advanced practice nurses and other healthcare providers) attention but are often ignored and underdiagnosed in the pediatric population (Faruqui, Khubchandani, Price, Bolyard, & Reddy, 2011). “Sufficient amounts of good quality sleep are necessary for healthy development in childhood” (Bordeleau, Bernier, & Carrier, 2012, p. 254). Inadequate sleep in children has been linked to numerous adverse outcomes psychologically as well as physically (Owens, Jones, & Nash, 2011). The American Academy of Pediatrics (AAP), issued recommendations in 2002 stating screening for snoring, one …

Results And Lessons Learned From A Nurse Practitioner-Guided Dementia Care Intervention For Primary Care Patients And Their Family Caregivers, Richard H. Fortinsky, Colleen Delaney, Ofer Harel, Karen Pasquale, Elena Schjavland, John Lynch, Alison Kleppinger, Suzanne Crumb

Articles - Patient Care

Older adults with dementia care needs often visit primary care physicians (PCPs), but PCP dementia care limitations are widely documented. This study tested the value of employing a nurse practitioner (NP) with geropsychiatric expertise to augment PCP care for newly and recently diagnosed patients and family caregivers. Twenty-one dyads received the NP intervention; 10 dyads were controls. Outcomes included patient neuropsychiatric symptom and quality of life changes, and caregiver depression, burden, and self-efficacy changes. Intervention acceptability by patients, caregivers, and PCPs was determined. No outcome differences were found; however, the NP intervention was deemed highly satisfactory by all stakeholders. Patients …

Factors Associated With Abnormal Weights In Infants In The First Year Of Life: Results From The 2010 National Ambulatory Medical Care Survey, Nikaela R. Larossa

Honors Scholar Theses

Purpose: To examine the predictors associated with abnormal infant weights for lengths in the first year of life as seen in ambulatory care settings.

Data Sources: A secondary data analysis was conducted using the 2010 National Ambulatory Medical Care Survey (NAMCS), in which practitioners documented single patient visits. World Health Organization (WHO) growth charts and recommendations were used to evaluate infant weight for length. Of the total visits, 603 infants were less than one year old, and 595 infants were within the length range of the WHO growth charts. Of the 595 cases, 13.6% were underweight, 5.5% were overweight, 41.2% …

Interventions To Minimize Distress During Pediatric Primary Care Visits: A Systematic Literature Review, Michelle Lee Smith

Student Works

Purpose: This literature review is designed to analyze interventions to minimize trauma and psychological stress experienced by pediatric patients during visits with their primary care providers. Data Sources: An electronic search of the literature was conducted to identify studies from 2008 to 2014 in the following databases: CINAHL, MEDLINE, PsycINFO, and the Cochrane library. Conclusions: Interventions to reduce a child's anxiety are available and easily executed. When anxiety is decreased, children are able to approach medical situations with a sense of comfort, achievement, and control. Decreasing stress can assist children in developing trusting relationships of the health care system as …

Assessing Blood Pressure Control In Primary Care, Ashley W. Guiliani

DNP Projects

Purpose: To evaluate provider adherence to JNC 7 by assessing documentation of blood pressure control and interventions in the absence of control in order to assist providers in reaching Healthy People 2020 goal of blood pressure control.

Methods: A retrospective chart review was conducted for patients with essential hypertension. Data collected included blood pressure, use of a home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three visits. A provider survey regarding provider barriers to blood pressure control was also completed.

Results: All surveyed providers were aware and …

Assessment Of Pediatric Primary Care Providers Behaviors And Procedures Regarding Pediatric Overweight And Obesity, Jessie N. Meiser

DNP Projects

CAPSTONE INTRODUCTION

Childhood overweight/obesity is a critical public health problem with devastating consequences. Many factors have combined to create the epidemic, and primary care providers can play an important role in addressing the problem by identifying overweight/obese children and encouraging them to engage in healthy behaviors. However, providers face a number of competing priorities making it difficult for them to provide these services effectively without outside support.

Obesity has reached an epidemic proportion in the nation’s youth. The Data Resource Center for Child and Adolescent Health (2011) found that 35.7% of children age 10 – 17 in Kentucky are overweight …

Delivery Of Evidence-Based Tobacco Use Interventions In Primary Care, Amber Silberman

DNP Projects

This capstone report presents three manuscripts which focus on tobacco use interventions in the primary care setting. The first manuscript presents a critical analysis of the Public Health Service guideline on Treating Tobacco Use and Dependence. The second manuscript presents a literature review pertaining to interventions that increase primary care provider compliance with guideline recommendations. The literature obtained from these first two manuscripts led to a descriptive study, which examined the documentation and implementation of specific guideline recommendations in a primary care clinic. The third and final manuscript details this study, and presents some practical implications for improving documentation …

Best Practice Guideline For Managing Interstitial Cystitis In Adult Women, Amanda Thomas Langford

Theses and Dissertations

Interstitial cystitis/painful bladder syndrome (IC/PBS) is a chronic disease characterized by symptoms of urinary urgency, frequency, bladder pain, and chronic pelvic pain in the absence of known pathology. Selection of appropriate treatments depended on the severity of the patient's symptoms and patient's preference. This review found that it is important for providers and patients to set realistic goals for symptom improvement when starting a new treatment.

The purposes of this project was to 1) conduct a substantive literature review on treatment guidelines for IC/PBS, 2) analyze the literature for comparing oral pharmacological interventions and behavioral interventions for IC/PBS, and 3) …

Influences Of Health Insurance And Primary Care On Breast And Cervical Cancer Screening Among Black Women In Boston, Gail Barlow Gall

Graduate Doctoral Dissertations

Healthy People 2010 promoted breast and cervical cancer screening to reduce cancer among all women and reduce disparities in cancer deaths between Black and White women. The REACH 2010 program targeted improving screening rates among Black women and funded a demonstration project to provide outreach, screening, patient navigation and case management for Black women in Boston. The purpose of this study was to describe associations between health insurance and primary care (having a primary care provider [PCP], quality of communications and relationship with PCP) on differences in breast and cervical cancer screening reported by Black women born in the United …

Instituting An Oral Health Preventive Service Program, Including Fluoride Varnish, For Preschool Children Birth To Five Years In A Rural Health Clinic: A Clinical Scholarship Project, Carol Ann Berger

Dissertations

Abstract This project was designed to institute an oral health preventive program in a rural health clinic, in a dental provider shortage area, promoting oral health in preschool children birth to five years by: (a) instituting a program that supports the Missouri preventive service program in oral health, (b) promoting oral screenings and fluoride varnish twice yearly, (c) assessing the risk of caries, (d) referring to appropriate dental services and (e) educating parents or guardian about the importance of oral health and how to maintain oral health at home with children birth to five years. This project sought to answer …

Paramed Home: A Protocol For A Randomised Controlled Trial Of Paramedic Assessment And Referral To Access Medical Care At Home, Glenn Arendts, Moira Sim, Steven Johnston, Richard Brightwell

Research outputs 2011

Background: In Australia approximately 25% of Emergency Department (ED) attendances are via ambulance. ED overcrowding in Australia, as in many countries, is common. Measures to reduce overcrowding include the provision of enhanced timely primary care in the community for appropriate low risk injury and illness. Therefore paramedic assessment and referral to a community home hospital service, in preference to transfer to ED, may confer clinical and cost benefit.

Methods/Design: A randomised controlled trial. Consenting adult patients that call an ambulance and are assessed by paramedics as having an eligible low risk problem will be randomised to referral to …

Identifying Patients At Risk For Obstructive Sleep Apnea In Primary Health Care : Can Obesity In Combination With Other High-Risk Diagnoses Be Used For Screening Purposes?, Clelia Lima

Electronic Theses and Dissertations

Obstructive sleep apnea (OSA) affects about 15 million adults in the United States, and is an independent risk factor for all-cause mortality. The under-diagnosing of OSA has been linked to the inadequate screening by primary care practitioners (PCPs). Existing screening tools are not widely used by PCPs possibly due to time constraints they experience as providers. This study demonstrates how common high-risk diagnoses (obesity, hypertension, diabetes mellitus type 2, dyslipidemia, arrhythmia, and coronary artery disease) can be used to help PCPs identify adult patients at risk for OSA. Unlike other screening tools, these diagnoses are easy to identify in a …

Office Nurse Educators: Improving Diabetes Self-Management For The Latino Population In The Clinic Setting, Dawn Weiler, Laura Tirrell

Nursing Faculty Publications and Presentations

Diabetes patients who understand their disease and how to manage it can achieve a lower complication rate. The American Diabetes Association recommends that patients receive self-management education and that patients' skills and knowledge be reassessed annually. The Healthy People 2010 objectives include a goal of at least 60% of diabetes patients receiving diabetes education. However, to date overall, far fewer (20%–50%) obtain comprehensive diabetes education and skills development to effectively implement self-management techniques. Low-income Latino patients generally fare even worse. This article describes a successful method to address this problem: the development and evaluation of an in-house diabetes education program, …

Chronic Pain: Nurse Practitioners' Attitudes And Interventions In Primary Care, Brenda Kay Thornton Coggins

MSN Research Projects

Chronic pain is a widespread problem affecting millions of people. Research has shown that attitudes and beliefs toward pain influence actions and reactions of both the person experiencing pain and the health care provider. Research has also shown that some health care providers have negative attitudes and erroneous beliefs about pain. This descriptive study was undertaken to explore and describe attitudes of nurse practitioners in primary care settings in Mississippi toward chronic pain and their subsequent interventions for chronic pain. Travelbee's Human-to-Human Model was utilized as the theoretical framework for this study. The two research questions asked in this study …