Nursing Commons^™

Use Of Anticipatory Guidelines In Late Infants And Toddlers 12 To 24 Months In Primary Care, Claire E. Eller

Doctor of Nursing Practice Projects

Anticipatory guidance is a well-known and utilized method that has been implemented in a majority of pediatric primary care offices. As the need for efficiency grows and increasing patient volumes climb, there is a growing need for strategies to provide this information effectively and efficiently. Prior evidence can be utilized to identify the most critical knowledge caregivers and parents will require. Our findings indicate safety, communication, nutrition, social development, and behavior as cornerstone topics for anticipatory guidance. To increase the volume of education provided to parents and caregivers, alternate methods beyond verbal discussion could be used. After gathering scientific literature …

Advanced Care Planning In Primary Care, Kaylee Beals, Amanda Merriman

Doctor of Nursing Practice Projects

In Illinois, the do-not-resuscitate (DNR) form that is legally binding in all healthcare facilities is known as the Practitioner Orders for Life-Sustaining Treatment (POLST) form. The Patient Self-Determination Act (PSDA) of 1991 mandates only certain facilities to discuss advanced care planning (ACP). Primary care offices are not included in this mandate. Therefore, no structured process exists for primary care providers to identify patients who may benefit from ACP discussions. The purpose of this Doctor of Nursing Practice (DNP) project was to initiate conversations about ACP with patients 55 years and older in a primary care office and complete POLST forms …

Improving Health Prevention Screening In A Rural Health Clinic, Shawn M. Mcnally

Masters Projects

Background: Health prevention screening has recently been highlighted in many initiatives from leading countries around the world. Breast cancer screening, cervical cancer screening and osteoporosis screenings are among the highest objectives for many of these initiatives as national health agencies focus on reducing morbidity and mortality by early detection.

Local problem: Baseline quality metrics reported for one clinic show the appropriate ordering of these health screenings is below the national benchmarks and the organizational benchmarks.

Methods: The project was designed as a quality improvement project based in a critical access region serving a rural population.

Interventions: The project intervention …

Implementation Of The Stop-Bang Screening Tool In The Primary Care Setting: A Quality Improvement Project, Thriciana Powell

DNP Projects

Significance and Background. There are approximately 25 million adults in the United States with obstructive sleep apnea (OSA). OSA is a sleeping disorder that is caused by periodic airflow blockage during sleep. It has been linked to numerous health problems and within the primary care setting OSA is not routinely screened for at visits. This leads to delayed diagnosis of a serious health issue and the potential for poor health outcomes. The STOP-BANG questionnaire (SBQ) is a simple eight-question tool that is used to screen patients for OSA. The STOP section focuses on snoring, tiredness, observed apnea, and high blood …

Evaluating The Impact Of A No-Show Policy: A Quality Improvement Project, Adrianne S. Harding

DNP Projects

Significance and Background: No- shows are a global problem that creates a significant challenge for the healthcare system. When a patient misses an appointment, it decreases health care staff productivity, creates a waste of resources and it negatively impacts revenue (Lance et. al, 2021). Current evidence supports interventions that incorporate voluminous data and artificial intelligence with strategies such as overbooking, appointment notification systems and financial incentives to reduce outpatient no-shows (Oikonomidi et al., 2022). This project will evaluate the impact of a no-show policy and provide insights to improve primary care attendance and inform decisions.

Purpose: To evaluate an outpatient …

Recognizing Barriers In The Elderly Population And Increasing Access To Case Management Services, Loveleena Alex

Doctor of Nursing Practice Projects

Abstract

Implementing case management can lead to fewer hospitalizations in the elderly population. Barriers influencing the number of hospitalizations include low socioeconomic status, transportation needs, health literacy, financial strain, multiple comorbidities, underserved populations, medication availability, availability of community resources, and access to primary care. A review of the available literature revealed that by addressing these barriers in a primary care setting and implementing case management, the number of hospitalizations can be decreased and the quality of life in the elderly population can be improved. This quality improvement project implemented a screening and referral process for chronic care management in the …

How Provider Education On Identification And Referral Of Eligible Patients To A Care Management Program Affects Readmission Rates: An Evidence-Based Project, Kosisochi Agube

Doctor of Nursing Practice Projects

Hospital readmissions cost the U.S. healthcare system approximately $17.4 billion each year. Minimizing hospitalizations among Medicare beneficiaries is therefore a high priority. This study aimed to evaluate how identifying patients at high risk of hospital readmission—i.e., patients with complex health needs, such as those with chronic conditions—and referring them to a transitional care program impacts readmission rates in a primary care clinic. The PI hypothesized that identifying high-risk individuals and enrolling them in a care management program to improve their health would lessen their need for inpatient and other high-cost healthcare services.

The PICOT question for this project is as …

Impact Of Teamstepps Training On Teamwork Perception In Two Primary Care Clinics, Brittaney Shaw

Doctor of Nursing Practice Projects

Background: Most healthcare delivery involves teams. After teamwork and communication breakdowns, poor patient care, errors, and inefficiencies follow. Employee engagement surveys from two Galveston County clinics showed concern with teamwork and value. TeamSTEPPS, a team training program, improved attitudes, knowledge, and outcomes, according to the Agency for Healthcare Research and Quality. Purpose: The project examined how TeamSTEPPS training affected healthcare professionals’ and administrative employees at two Galveston County primary care clinics' teamwork perspectives. PICOT Question: Among entire staff in two primary care clinics (P), what is the impact of TeamSTEPPS (I) on improving teamwork perception (O) comparing pre-post TeamSTEPPS Teamwork …

Type 2 Diabetes Nutrition: A Video-Based Education Approach, Erin Russell

Masters Projects

Background: Type 2 diabetes mellitus (T2DM) is a chronic disease associated with life- threatening outcomes. To prevent such outcomes, people with diabetes must possess the knowledge and skills required to manage their chronic disease. Objectives: To evaluate the impact of video-based education (VBE) on participant Diabetes Self-Management Education Skills (DSMES). Methods: The experimental study was conducted in a primary care office in a Midwest state. A convenience sample of 55 participants was selected. Pre- and post-implementation surveys were administered to measure change in self-efficacy between DMSES scores after viewing the VBE intervention. The Wilcoxon Rank Sum test was performed using …

Implementation Of Collaborative Care Intervention Within A Fqhc To Achieve Uniform Data System (Uds) Measure Of Depression Remission, Rasha A. Kafi Msn, Rn, Fnp-C

Doctor of Nursing Practice Projects

Background: Depression is one of the most common and treatable mental health conditions. Untreated depression causes emotional suffering, reduced productivity, lost wages, increased comorbidity risks, and increased healthcare costs.

Purpose: The purpose of this project was to implement Collaborative Care Interventions (CCI) to achieve the Uniform Data System (UDS) Measure of Depression Remission.

Aims: The AIMS of this project were: (a) Increases the percentage of nursing staff compliance and completion of the educational training; (b) increases nursing staff knowledge of recognition of depression signs and symptoms, early identification of depression, and administration to all adult patients; (c) Increase the percentage …

Nurses' Understanding And Management Of Iron Deficiency In Australia: A Cross-Sectional, Exploratory Study, Therese A. O'Sullivan, Pradeep H. Jayasuriya, Natalie Tsalis, Nina Calogero, Ramesh Manocha

Research outputs 2022 to 2026

Objectives: To assess the experiences and knowledge of nurses in the area of iron deficiency. Design: A cross-sectional, exploratory study using online survey. Setting: Data were collected from nurses working at various primary, secondary and tertiary Australian health practices and organisations. Participants: Australian nurses currently in practice. Method: Australian nurses currently in practice were invited to complete an online survey about their work background, personal experiences with iron deficiency and iron-deficiency identification and treatment. The survey included a nine-item questionnaire to assess knowledge of iron-deficiency risk factors and biochemistry. Results: A total of 534 eligible nurses participated in the survey. …

Access To And Utilization Of Primary Care: A Synthesis, Klaire M. Johnson

Kentucky Journal of Undergraduate Scholarship

Barriers to access and utilization of primary care affect nearly 9% of the nation’s population (USDHHS, n.d.a). These barriers are important to evaluate for members of the aging population due to increased need for health care as a result of chronic conditions and falls. Research indicates that access for the aging population is affected by a variety of factors, including: transportation, non-financial barriers, and internal factors. Issues surrounding current delivery of care, such as a workforce shortage of primary care physicians, have compounded the problem even further. While this issue has begun to be addressed through the Affordable Care Act, …

Creating A Primary Care Track In Prelicensure Nursing Education, Janice E. Hawkins, Lynn L. Wiles, Jamela Martin, Beth Tremblay, Karen Higgins, Ingrid Mahoney

Ellmer School of Nursing Faculty Publications

BACKGROUND: RNs practicing in primary care (PC) increase access to health care and contribute to better patient outcomes and cost savings, yet undergraduate nursing education traditionally focuses on disease-oriented care. This article describes a curricular track for infusing PC prelicensure programs.

METHOD: PC content is threaded across four semesters with targeted assignments and clinical experiences. Providing clinical immersion experiences with practicing RNs as preceptors in community and PC settings is a key component of this initiative.

RESULTS: Student feedback has been favorable. Students stated they gained insight to the role of RNs in PC through class assignments and clinical rotations. …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

Evaluating The Feasibility And Efficacy Of A Brief Motivational Interviewing Nutrition Intervention For Women With Type 2 Diabetes In Primary Care, Charlotte M. Adams

DNP Projects

Background: The American Diabetes Association recommends lifestyle modification to prevent and treat diabetes in their 2021 Standards of Medical Care in Diabetes. Evidence suggests that motivational interviewing (MI) is an effective intervention that clinicians can use to facilitate behavior change in patients with type two diabetes.

Purpose: The purpose of this project was to evaluate a brief motivational interviewing intervention that could be delivered by a PCP to provide individualized nutrition counseling for adult women with type two diabetes in a primary care clinic in Lexington, KY. This study was a continuation of a previous quality improvement project at this …

Evaluating Providers’ Knowledge, Attitudes, And Intentions Toward Utilizing First Post-Discharge Visit Checklist In Primary Care To Reduce Readmissions In Heart Failure Patients, Binu Bashyal

DNP Projects

Background and Significance: Heart failure (HF) affects approximately 6.2 million adults in the United States and 40 million people globally. HF is one of the leading causes of emergency department (ED) visits and hospitalizations in adults. Twenty percent of patients admitted for HF are readmitted within thirty days, and up to fifty percent are readmitted by six months. A First Post-Discharge Visit checklist could help mitigate the problem of readmission.

Purpose: The purpose of this DNP project was to evaluate primary care providers’ knowledge, attitudes, and intentions towards utilizing the First Post-Discharge Visit checklist to reduce hospital readmissions among …

Improving Self-Efficacy Of Primary Care Providers With Assessment Of Diabetic Peripheral Neuropathy, Kimberly Paddock Farr

Walden Dissertations and Doctoral Studies

AbstractDiabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes. DPN contributes to significant pain, debility and injury to diabetic patients. The majority of diabetic patients are managed in the primary care practice (PCP) setting. A local chapter of a nurse practitioner association identified a lack of knowledge of current evidence-based guidelines for effective screening and assessment of DPN in the PCP environment. The practice-focused question for this project was to determine if an educational intervention on evidence-based screening and assessment would improve nurse practitioner’s knowledge with DPN screening and diagnosis in PCP. Mezirow’s transformative theory of …

A Global Perspective Of Advanced Practice Nursing Research: A Review Of Systematic Reviews Protocol, Kelley Kilpatrick, Isabelle Savard, Li-Anne Audet, Abby Kra-Friedman, Reneé Atallah, Mira Jabbour, Wentao Zhou, Kathy Wheeler, Elissa Ladd, Deborah C. Gray, Colette Henderson, Lori A. Spies, Heather Mcgrath, Melanie Rogers

Ellmer School of Nursing Faculty Publications

Introduction

In 2020, the World Health Organization called for the expansion and greater recognition of all nursing roles, including advanced practice nurses (APNs), to better meet patient care needs. As defined by the International Council of Nurses (ICN), the two most common APN roles include nurse practitioners (NPs) and clinical nurse specialists (CNSs). They help ensure care to communities as well as patients and families with acute, chronic or complex conditions. Moreover, APNs support providers to deliver high quality care and improve access to services. Currently, there is much variability in the use of advanced practice nursing roles globally. A …

Registered Nurse-Led Annual Wellness Visits In Rural Health Clinics: A Program Evaluation Of A New Role, Tina Switzer

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

The passage of the Patient Portability and Affordable Care Act had a goal of increasing access for preventive care. The Medicare Annual Wellness Visit (AWV) has been a free yearly, comprehensive preventive care opportunity for most Medicare beneficiaries since 2011. Because of the time intensive nature of these visits, the overall national completion rate for them has been low as providers often perceive time and resource constraints. Registered Nurses (RNs) have the skill set to complete these visits with minimal provider involvement. Rural residents often face health care access barriers and outcome disparities, and Rural Health Clinics (RHCs) are a …

The Role Of Telehealth In Reducing Hospital Readmissions For Heart Failure Patients, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Heart failure affects over six million people annually, and is expected to increase to over eight million by 2030. Over 60 million people live in the rural United States. Telehealth is a tool to improve access to care, provide early intervention, and follow up with patients within 48 hours of a hospital discharge. Utilizing Telehealth to conduct a medication reconciliation within 48 hours of discharge to address any medication errors or admission, and reinforce adherence is a way to improve access to care to those living in rural areas.

Telehealth And Hospital Readmissions For Heart Failure Patients: A Literature Review, Tommy Lee Bratcher

Graduate Theses, Dissertations, and Capstones

Currently heart failure affects over six million people and is expected to increase to over eight million people by 20230. The US Census Bureau estimates over 60 million people live in a rural setting. This literature review seeks to determine the state of the science regarding the utilization of Telehealth to reduce heart failure readmissions in rural areas.

Implementation Of Routine Screening To Detect Early Cases Of Depression And Anxiety In Hispanic Adolescents In The Primary Care Setting, Latoya Hayward

Doctor of Nursing Practice Projects

Depression and anxiety are among the leading causes of illness and disability in adolescents and are two of the most prevalent mental health conditions in Latino youth. If left unrecognized and untreated, these conditions can lead to decreased quality of life and increased rates of suicide. Researchers recommend early mental health screening to occur in the primary care setting. Through routine screening using evidence-based screening tools (PHQ-9 and GAD-7), the primary goal of this quality improvement project was to increase early detection of depression and anxiety in primary care and initiate early treatment. Project methods included implementation of new workflow, …

Provider Knowledge And Confidence With Implementing Pediatric Adverse Childhood Experiences (Aces) Screening Tool In An Alaskan Family Practice Clinic, Lisa Marie Wangberg

Doctoral Dissertations and Projects

Adverse childhood experiences (ACEs) have been known to be associated with negative developmental and long-term health sequalae since Felitti and colleagues (1998) presented their groundbreaking research nearly a quarter of a century ago. Pediatric and primary care settings have been relatively slow to implement any type of ACEs screening at regular intervals such as at well-child exams (WCEs). A scholarly project implementation was used to present ACEs education and screening training to pediatric primary care providers in a small, private, rural family health care practice in Alaska. The goal of the project was to determine if providers felt more knowledgeable …

The Best Practice For Colon Cancer Screening Recommendations By Primary Healthcare Providers: An Integrative Review, Anna Lynn Viens

Doctoral Dissertations and Projects

Colorectal cancer screening is an important step toward reducing the mortality rate of this disease. Screening rates will improve with the utilization of trusted health care provider recommendations for patients. The purpose for a review of literature on best practices for colon cancer screening recommendations by providers is to increase the number of effective conversations between primary care providers and their patients around colorectal cancer, and, ultimately, to facilitate more provider screening recommendations for patients. This topic is important for reducing the burden of colon cancer. Providers would benefit from education and decision aids to assist with the colon cancer …

Diagnosis And Initial Management Of Acute Stress Disorder And Post-Traumatic Stress Disorder In The Primary Care Setting, Lindsay Leonard, Blaine Winters

Student Works

Purpose: The purpose of this paper is to equip nurse practitioners (NPs) with resources and tools that will help with the early recognition and treatment of Post-Traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD) in patients following a traumatic accident.

Background: According to the Centers for Disease Control and Prevention (2019), trauma, or unintentional injury, is the leading cause of death for individuals under the age of 45 and the third leading cause of death for all ages of people in the United States. Patients involved in traumatic accidents often develop adverse psychological sequelae such as PTSD and ASD. …

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

The Efficacy Of Tailored Text Messages To Improve Medication Adherence And Lifestyle Changes For Patients With Type 2 Diabetes Mellitus, Vanessa B. Silverio

Evidence-Based Practice Project Reports

Type 2 diabetes mellitus (T2DM) is a chronic disease characterized by increased amounts of glucose in the blood, and is the seventh leading cause of death in the United States (United Health Foundation [UHF]), 2021). T2DM can be effectively treated with medication and behavioral lifestyle modifications. Even small improvements in glycemic control can reduce the risk for debilitating complications such as heart disease, stroke, kidney disease, sepsis, and retinopathy (Wang et al., 2021, Haider et al., 2019). The purpose of this evidence-based practice (EBP) project was to identify the most effective intervention for improving medication adherence, lifestyle changes, and hemoglobin …

Utilizing A Personal Health Coach In The Management Of T2dm, Emily Killebrew, Matthew Huelsman, Verah Bonareri, Terri Furfaro

Doctor of Nursing Practice Projects

Management of type 2 diabetes mellitus (T2DM) can reduce hemoglobin a1c values and ultimately reduce the risk of morbidity and mortality. Many adults live with uncontrolled T2DM due to a lack of knowledge of disease management. The purpose of this project was to evaluate the implementation of a personal health coach for the management of T2DM in adult patients. An extensive literature review was conducted, and the use of the Diabetes Management Self-Efficacy Scale (DMSES) was chosen to evaluate participants’ self-efficacy regarding their T2DM. Adult patients aged 21-75 with a diagnosis of T2DM and a hemoglobin a1c >7 in a …

Improving Depression Surveillance At The We Care Clinic, Kaitlin Springer, Emma Hanney

Doctor of Nursing Practice Projects

Depression is one of the most underdiagnosed and untreated disorders affecting more than 16 million people in the United States each year (Henry et al., 2020). Unmanaged depression can lead to emotional suffering, decreased productivity, reduced income, impaired relationships, and an increased risk for comorbidities (Sinisalchi et al., 2020). It can affect anyone, however, individuals who are non-white, female, undereducated, disabled, pregnant or postpartum, have low socioeconomic status, or lack social support are at an increased risk (United States Preventative Services Task Force, 2019). The Southern Illinois University Edwardsville We Care Clinic provides primary care to minority patient populations who …

Improving Osteoporosis Screening Rates Of Women In A Primary Care Setting, Kristine E. Davis

Evidence-Based Practice Project Reports

Osteoporosis is caused by caused by low bone mass, microarchitecture disruption and increase in skeletal fragility (Rosen & Drezner, 2021). This disease presents as a silent disease without any clinical manifestations and increases risk for bone fracture. The purpose of this Evidence-Based Practice (EBP) project was to increase screening rates for osteoporosis in the female population by mailing a patient reminder letter to the home of qualifying patients in the primary care setting and to determine if mailing a patient reminder letter would increase screening rates. The Johns Hopkins Evidence-Based Practice for Nurses and Healthcare professionals (JHEBP) model was used …