Family Practice Nursing Commons^™

Knowledge And Attitude Of Nurses In A New Rn Graduate Residency Program Regarding Pain Management, Kathryn Lee Wampole

Doctoral Dissertations and Projects

Most people have encountered pain at some point in their lives. It is a very common complaint nurses hear from patients. When assessing patients, nurses are taught to take what the patient says as his or her pain level as fact. Pain is not a vital sign that can be measured with medical equipment like temperature or blood pressure. Therefore, many nurses find assessing pain challenging. Adding to the complexity of pain management is the current opioid crisis. To help combat some of these issues, the project leader worked with healthcare administrators at a regional teaching hospital in the southeastern …

Conflicts, Concerns And Family Circumstances In Custodial Grandmothers Over 8 Years, Cristina Noriega, Carol Musil, Jaclene Zauszniewski, Camille Warner

GrandFamilies: The Contemporary Journal of Research, Practice and Policy

Although many grandmothers raising grandchildren experience transitions in their roles as family strains and circumstances change, little longitudinal data has been examined. This qualitative study assessed the relationships between custodial grandmothers’ appraisals of their family conflicts and concerns and family circumstances across eight years. Participants were thirty-five Ohio grandmothers who were raising their grandchildren in 2006-2007 and provided additional self-report survey data in 2008-2009 and 2014-2015. Data were gathered from open-ended questions that were analyzed through conventional content analysis. The reported concerns were financial and emotional difficulties, grandchildren outcomes, mental and physical health of the grandchild and other family members, …

Enhancing Elderly Advance Care Planning Experience At A Primary Care Clinic, Oi Shan Wong

Doctoral Projects

The purpose of the project was to examine if the identification of readiness for an advance care planning (ACP) discussion of elderly participants would enhance the outcomes of participants' satisfaction, improve the likelihood of having an ACP discussion and increase the completion rates of an advance directive (AD) document after an office visit.

Forty-four elderly participants, who met the selection criteria, were recruited from a primary clinic in Northern California from October 1, 2017 to December 31, 2017 (Female, n =28). All participants were randomly assigned to either an intervention group (n= 22) or a control group ( …

What’S In A Name: Performance Improvement, Evidence-Based Practice, And Research?, Andrea Prentiss, Eve Butler

Nursing & Health Sciences Research Journal

No abstract provided.

An Educational Intervention To Raise The Awareness Of Limited Health Literacy And The Need To Utilize Recommended Strategies And Interventions Among Healthcare Clinicians In A Program Of All-Inclusive Care For The Elderly Setting, Esther Carpenter

Doctoral Dissertations and Scholarly Projects

Health literacy is a complex, common, and challenging issue facing the United States and the world today. Occurring in the context of care delivery and significantly impacting the quality of care provided, health literacy is not simply a patient problem; but places a substantial burden on healthcare clinicians to ensure they are providing clear communication. Research suggests a lack of awareness and training among healthcare clinicians related to health literacy, resulting in clinicians being unaware of and unprepared to address this issue in practice. The purpose of this evidence-based practice project was to raise the awareness of limited health literacy …

An Assessment Of Potentially Inappropriate Medications Among The Elderly And The Effect Of An Educational Intervention On Provider Knowledge Of These Medications, Amanda Brown

DNP Projects

Objectives: The aims of this study were to assess potentially inappropriate medications (PIMs) or Beers medications among outpatient older adults within one Midwestern healthcare system, to determine rates of patient education on Beers medications, and to pilot an educational intervention for providers.

Methods: This study involved two parts. For part 1 of the study, a randomized retrospective chart review of 493 older adult patients seen in 2017 from four practices was conducted to assess Beers medication prescriptions and rates of patient education. Following the chart review, for part 2 of the study, an educational intervention was delivered to two providers …

A Quality Improvement Initiative To Increase Statin Therapy Adherence Among Patients With Diabetes Aged 65 Years And Older, Kelly Nunemaker

Doctor of Nursing Practice

The purpose of this project was to improve statin therapy adherence among diabetic patients aged 65 and older treated at a small family practice clinic in western San Antonio. Additionally, the project aimed to decrease LDL cholesterol (LDL-C) levels in this patient population as recommended to 70 mg/dl or less. Diabetic patients are more likely to die from a cardiac event than patients without diabetes. Statin therapy is an important factor in lowering cholesterol, which reduces the patient’s risk for atherosclerosis. Educating patients aged 65 and older about the role of statin therapy in preventing cardiovascular events, stroke, and vascular …

Strategies To Improve Control Of Blood A1c In Diabetics, Jennifer Aronson, Leanne Bellino, Elizabeth Eisenhardt, Diane Bryant, Haley Pelletier, Internal Medicine Team, Adult Outpatient Clinic

MaineHealth Maine Medical Center

A1c monitoring is an important aspect of controlling the health of a diabetic patient. An adult internal medicine clinic noted that the percentage of their diabetic patients who had an A1c higher than 9 or no reading within the past year exceeded the national average. As a result, operational excellence methods were implemented with the overall goal to reduce their percentage to 18% or less.

A root cause analysis identified several deficiencies to includelack of essential equipment, variations in

staff education and the absence of daily reminders.

Post KPI implementations, an overall decrease in the percentage of patients with poorly …

Asthma Chronic Obstructive Pulmonary Disease Overlap Syndrome, Kimberly A. Babich-Speck

Nursing Student Class Projects (Formerly MSN)

Asthma and COPD often have symptoms that overlap. The area of overlap is known as asthma COPD overlap syndrome.

Implementing An Emr Change For The Diabetic Foot Assessment, Nicole O'Neil, Karen Sue Hoyt

Doctor of Nursing Practice Final Manuscripts

The purpose of this project was to implement the American Diabetes Association (ADA) foot assessment guidelines utilizing an electronic medical record (EMR) template. Aims of this evidence based practice (EBP) project were to improve documentation of the comprehensive diabetic foot exam, increase identification of loss of protective sensation (LOPS), and increase podiatry and vascular surgery referrals. Diabetes Mellitus (DM) causes many health complications. The lifetime risk of foot ulceration in diabetic patients is 25%. The goal of Healthy People 2020 is to increase this number by 10% to a total of 21,617,200 individuals. The ADA recommends annual comprehensive foot exam …

I’M A Big Kid Now: Enhancing Transition Rn Residents’ Confidence During Pediatric Patient Care, Emily W. Lam

Master's Projects and Capstones

The title of the clinical nurse leader project is “I’m a Big Kid Now: Enhancing Transition RN Residents’ Confidence During Pediatric Patient Care”. The project aims to improve the support components for Transition RN residents during their Transition RN Residency at Children’s Hospital Los Angeles. The clinical leadership theme that correlates to this project is communication. The clinical nurse leader’s role is to act as an educator and a facilitator throughout this project. In examining the clinical nurse leader competencies, competencies “use performance measures to assess and improve the delivery of evidence-based practices and promote outcomes that demonstrate delivery of …

Standardization Of Shift Report By Implementing A Nursing Report Sheet And Addressing Patient Values To Meet Patient Needs, Roman A. Salas

Master's Projects and Capstones

Bedside shift report is a complex process, which involves the transition of care from one clinician to another. The Agency for Healthcare Research and Quality (AHRQ) (2013) reported that approximately 70% of patient adverse events are attributed to communication failures between healthcare providers. Nurses remain inconsistent with information sharing during bedside shift report leading to communication gaps. The object of the clinical nurse leader (CNL) internship project is to provide true patient-centered by standardizing bedside shift report by implementing a nursing report sheet and addressing patient needs. The project was conducted in a level-one trauma center in San Diego, CA …

Preserving Dignity In The Long Term Care Of Actively Dying Residents, Libby-Rose Cronican

All College Thesis Program, 2016-2019

As one goes through the process of aging and approaches death, they experience a series of losses: from the loss of physical or mental ability to the ultimate loss of life. These losses make the individual vulnerable to harms that can come from a variety of sources. One source is found within the everyday interactions of long-term care nurses and aides with their elderly, dying residents. Creating this harm stems from a poor nursing practice where the nurse or aide fails to recognize and promote the resident’s dignity and autonomy. The normal notion of dignity and autonomy does not encompass …

Adult Qdts, Chinese, Marianne E. Weiss, Binghua Wang

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Evaluation Of A Nurse Navigator Program On The 30-Day Readmission Rate In Heart Failure Patients, Katie A. Winiger

DNP Projects

PURPOSE: The purpose of this study was to evaluate the impact of a registered Nurse Navigator (NN) on hospital 30-day readmissions for patients with heart failure at Norton Healthcare (NHC) in Louisville, Kentucky.

METHODS: This study involved two phases. Phase I was a retrospective descriptive design utilizing a medical record review of 159 patient charts. Group 1, 54 charts, included patients with heart failure who were discharged from NHC for heart failure related illnesses and were seen in a primary care clinic that utilized a NN after discharge from the hospital. Group 2, 105 charts, included patients with heart failure …

Decreasing Cost Associated Medication Nonadherence, Shawn E. Raymond

Doctor of Nursing Practice Scholarly Project

An Abstract of the Scholarly Project by

Shawn E. Raymond

Medication cost is a major contributor for patient medication nonadherence. Take in the fact that a large population lives in poverty, many cannot afford to pay the retail prices associated with purchasing their medications. By incorporating wholesale medications into a charitable health clinic, the reduced cost of medications for treatment of both acute and chronic illnesses could be passed on to those in need thereby decreasing cost associated medication nonadherence. Nurse Practitioners in the state of Kansas are not afforded the privilege to purchase, repackage and distribute or resell wholesale …

Undiagnosed Depression In The Elderly And Healthcare Education, Nancy J. Wynn-Grundy

Doctoral Projects

This descriptive study examined undiagnosed depression in the elderly and how it affects the elderly from retaining healthcare education. It is estimated by 2029, 20% of the United States population will be age 65 and older (Colby & Ortman, 2014). Depression in the elderly who have chronic diseases, is estimated to be undiagnosed up to 40% (Chaoyang et al., 2009). A hallmark symptom of depression is the inability to concentrate. It is unknown if undiagnosed depression will affect the older adult from retaining pertinent healthcare education. The 30 point Geriatric Depression Scale (GDS) was administered to a class of elderly …

Retention Of Cardiopulmonary Resuscitation Knowledge And Psychomotor Skill Among Undergraduate Nursing Students: An Integrative Review Of Literature, Fernanda Tirado

Honors Undergraduate Theses

Purpose: The purpose of this integrative literature review is to explore the effectiveness of different training modalities on the acquisition and retention of CPR knowledge and psychomotor skill among undergraduate nursing students. Background: It is well known that standard CPR-training is ineffective at preparing nurses for the rigors of a cardiac arrest event. Survival rates for in-hospital cardiac arrests remain low and the proportion of neurobehavioral sequelae among survivors is very high. Methods: A review of relevant literature published between 2006 and 2016 was conducted using the CINAHL and MEDLINE databases. The following key terms were used in the search: …

Evaluation Of Serum Vitamin D Levels In Older Adults Who Fall And Sustain A Fracture: A Retrospective Chart Review, Suzanne L. Pilon

DNP Projects

Purpose: This practice inquiry project was designed to (i) evaluate serum vitamin D levels in individuals aged 65 years and older who had fallen and sustained a fracture and (ii) identify if the serum vitamin D levels were within therapeutic range.

Background: Older adults are at increased risk of falling and sustaining a fracture as a result of falls. Vitamin D has been shown to be effective in fall prevention yet vitamin D is deficient in the older population worldwide. Evaluating current serum vitamin D levels in older adults who fall and sustain a fracture may provide additional insight in …

Beers Medication: Empowering The Elderly Through Education, Amanda J. Parker

DNP Projects

The elderly population (those aged 65 years and older) has an increased risk of experiencing adverse effects from their prescribed medications. These adverse effects are due to many reasons, one being changes that naturally occur in the aging body, such as diminished kidney function or decreased gastrointestinal motility. This project explores the prescribing practices of one primary care practice setting. Specifically, this project sought to determine the number of patients in a primary care practice who were prescribed medications on the Beers list and whether or not the patients received education on adverse effects. The results concluded the most frequently …

Recognizing Pain Using Novel Simulation Technology, Justin C. Grace

Honors Undergraduate Theses

Effective pain management and time to treatment is essential in patient care. Despite scientific evidence supporting the need to treat pain and an emphasis on addressing pain as a priority, pain management continues to be an unresolved issue. As a member of the health care team, nurses are integral to optimal pain management. Currently, nursing schools have limited innovative or alternative methods for teaching pain assessment and management. Simulation in nursing education provides a unique opportunity to expose students to realistic patient situations and allow them to learn and make mistakes without causing harm. However, modern low- and high-fidelity simulation …

Telephone Calls To Reduce 30-Day Readmissions For Older Adults With Heart Failure, Juanette G. Clark

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this evidenced based practice project was to evaluate the effectiveness of discharge follow-up calls for heart failure (HF) patients recently discharged from a private hospital.

Background: HF is the number one discharge diagnosis among patients 65 years and older. It affects 5.8 million people in the United States. HF admissions total (1) million annually, however, 24% of these patients are readmitted within 30 days of discharge. Re-hospitalizations are associated with high mortality rates and expenditures approximated at $13,000 per patient contributing to the overall annual expenditure of $33.7 billion. In 2012, the Centers for Medicare …

Gap In Patient Expectations Of Deep Brain Stimulation For The Treatment Of Parkinson's Disease, Colleen D. Knoop Dnp-C

Graduate Theses, Dissertations, and Capstones

Abstract

Purpose: This project studied a specific group of patients with Parkinson’s disease to: determine if they were asked to verbalize expectations of DBS pre-operatively; determine if patient expectations were met post-operatively; gain information that could aid in improved pre-operative patient education for deep brain stimulation (DBS), address unrealistic expectations before surgery, and meet patient expectations post-operatively.

Methodology: This study was a retrospective, single academic center, two-part design that included a questionnaire and chart review of 29 patients. Those included were patients with Parkinson’s disease who had DBS programming at the academic center, between the years 2007 and 2014.

Results: …

Clinical Effectiveness Of Inr Patient Self-Testing: Adults On Warfarin Therapy In Private Practice, Anisa Munshi

Doctor of Nursing Practice Final Manuscripts

Background: Warfarin is the most commonly prescribed oral anticoagulant for the prevention and treatment of venous thromboembolism. Due to its narrow therapeutic index, warfarin requires close monitoring of the international normalized ratio (INR) to ensure proper anticoagulation control and safety. INRs outside of this range are strongly associated with an increased risk of major bleeding, thromboembolic events, and death. Patient self-testing (PST) using a point-of-care device allows patients to monitor INR results at home. Evidence shows that PST improves the clinical outcomes of warfarin therapy compared to usual care, which includes laboratory INR monitoring. Purpose: To compare the clinical effectiveness …

Rural Healthcare Providers' Behavioral Intentions With Hospice Referrals: Attitudes, Knowledge, Beliefs, Benefits And Barriers, Meki Jacobs Graham

Nursing Theses and Capstone Projects

As hospice programs gain recognition, hospice referrals are gaining momentum. Yet for multiple reasons hospice referrals are challenging amongst rural healthcare providers (HCPs). For rural healthcare providers, lack of knowledge about hospice services and care contributes to a decrease in hospice referrals. The purpose of this capstone project was to develop an intervention to improve rural health care providers' behavioral intention to make hospice referral. The study sought to determine if an educational intervention would improve behavioral intentions to make a hospice referral resulting in increased hospice referral rates. Outcome data was based on utilizing a pretest/posttest survey design. An …

Ob-Pdcds Spanish, Marianne E. Weiss, Gabriella Malagon-Maldonado

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Ob Qdts, Spanish, Marianne E. Weiss, Gabriella Malagon-Maldonado

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Ob-Pdcds Spanish, Marianne E. Weiss, Gabriella Malagon-Maldonado

Quality of Discharge Teaching Scale

The Readiness for Hospital Discharge Scale, Quality of Discharge Teaching Scale, and Post-Discharge Coping Difficulty Scale were developed by Dr. Marianne Weiss to measure nurse-sensitive discharge care processes and patient outcomes. Three versions of the scales were developed concurrently for different patient populations – Adult medical-surgical patients, Parents of hospitalized children, and Postpartum Patient mothers (see Weiss & Piacentine, 2006, Weiss et al., 2007, and Bobay et al., 2018 for description of the development and initial testing). Additional scales and information about translation rights are located at Marquette Nursing.

PERMISSION TO USE

The Readiness for Discharge Scale, Quality of Discharge …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Primary Care At Home: Nurse Practitioners' Perceptions And Practices, Tonya Bragg-Underwood

Doctor of Nursing Practice Technical Reports

Background: Primary care at home is not a new idea, but rather a reinvention of an old and almost forgotten practice. Today, only 1% of primary care visits are provided in a home setting; despite the increasing aging homebound population in the United States. Current primary care at home research relates improved patient outcomes with primary care at home visits. Primary care at home is reemerging in the United States, but currently is not generating many positive reviews. There is a gap in the current primary care at home literature regarding nurse practitioner home visit practices and perceptions. Methods: A …