Improving Culturally Competent Lgbtq+ Care Among Primary Care Providers, Christopher Diaz

Doctor of Nursing Practice (DNP) Projects

Purpose: Although general efforts have been made to identify, address, and improve the standing of the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) community, many of these individuals continue to experience stigmatization and discrimination daily. These experiences influence the health of these individuals, which leads to several health disparities including an increased risk for numerous physical and mental health conditions.

Methods: Using nationally developed guidelines, the author of this project developed two didactic-style educational presentations for primary care providers to improve cultural competency for LGBTQ+ individuals. Eight providers completed both presentations, which explored the attitudes, knowledge, and beliefs/practice intentions of …

Outcomes Of Directly Observed Therapy In People Living With Hiv Who Experience Homelessness And Substance Use Disorder, Mara C. Clawson

Doctor of Nursing Practice (DNP) Projects

Background: Antiretroviral directly observed therapy, in which nurses or other allied health professionals provide patients with daily medication, is an evidence-based solution for viral load suppression in people living with HIV who experience homelessness. Purpose: This quality improvement project aimed to assess the outcomes of antiretroviral directly observed therapy at one urban clinic caring for people living with human immunodeficiency virus who experience homelessness and substance use disorder. Methods: Data was collected from the electronic health record for the antiretroviral directly observed therapy patient cohort (n = 33); 10 of them were surveyed. Fisher exact tests determined nonrandom associations between …

Implementation Of An Acne Management Smartset To Guide Primary Care Providers’ Management Of Acne Patients, Emily Thomas

Doctor of Nursing Practice (DNP) Projects

Background: Primary care providers (PCPs) commonly refer adult acne patients to dermatology due to lack of confidence in treatment initiation and maintenance, resulting in delayed patient care, limited access to dermatology appointments, and an ongoing knowledge gap within the primary care setting. Purpose: To support PCPs with acne diagnosis and treatment recommendations by hosting acne education sessions and implementing an Acne Management SmartSet for acne treatment. Methods: The DNP student held acne education sessions during staff meetings at two primary care sites, then disseminated surveys to participants to determine if the education session and SmartSet were clinically useful. Data pertaining …

Improving Dementia Caregiver Competency In Nursing Home, Disha Bhattacharya

Doctor of Nursing Practice (DNP) Projects

Background: Inadequate training of dementia care providers in nursing homes lead to adverse health outcomes in patients with dementia.

Purpose: To educate and train dementia caregivers in a nursing home to improve dementia care.

Methods: A Quality Improvement Project (QIP) was implemented in a nursing home with nine nurses engaged in two virtual education group sessions led by the DNP student over an eight- week timeframe. Topics discussed included education on the nature and progress of dementia, building trust with dementia patients, managing their behavior, communication strategies, and self-care. Pre-training and post-training surveys were completed prior to …

Promoting Exclusive Breastfeeding Among Racing/Ethnic Minority Women For The First Six Months, Linda A. Boateng

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Breastfeeding is the recommended way of feeding infants due to the numerous health benefits. However, racial/ethnic minority women in the United States are less likely to initiate and maintain breastfeeding for the recommended six months compared to white women. This has resulted in higher health issues such as obesity, diabetes type I, allergic sensitivity, acute otitis media, and gastrointestinal problems among racial /ethnic minority children. Purpose: The purpose of this Quality Improvement Project was to promote exclusive breastfeeding among racial/ethnic minority postpartum mothers for the first six months. This was done by providing breastfeeding education to postpartum nurses …

Enhancing Preventative Health Care For Latino Migrant Dairy Farm Workers In Addison County, Vermont, Elizabeth A. Douglas

Doctor of Nursing Practice (DNP) Projects

Background: Latino dairy farmworkers, mainly from Mexico and Guatemala, help produce over 50% of Vermont’s milk. Latino dairy farmworkers may not seek health care for many reasons, including fear of immigration/law enforcement, language barriers, lack of transportation, and cost of care. Purpose: The purpose of this DNP project was to increase the utilization of health care services, including immunizations, of migrant farmers by educating and providing information about preventative, curative, and support services available in southern Vermont (VT). Methods: The intervention, one 60-minute educational program session took place at a local church service for migrant farmers, and an informational pamphlet …

Improvement Of Overweight And Obesity Screening And Intervention In Primary Care, Catherine Lehtinen

Doctor of Nursing Practice (DNP) Projects

Background: Obesity is a chronic health condition, resulting in significant morbidity and mortality, and is inadequately managed and treated in primary care. The Obesity Pathway is an organization-specific algorithm for providers to treat patients with obesity.

Purpose: To improve provider use of an Obesity Pathway in a primary care clinic and to increase the screening and intervention of all adult patients with overweight or obese status.

Methods: The Obesity Pathway was reviewed with primary care providers as well as best practices for weight management, obesity bias and stigma. The NEW Attitudes Scale and satisfaction surveys were completed by providers before …

Improving Telehealth Knowledge And Comfort In An Older Adult Population, Carolyn J. Jones

Doctor of Nursing Practice (DNP) Projects

Background: Telehealth usage is increasing a means of providing healthcare in a more efficient and cost-effective way. Older adults have been left behind from the telehealth movement and this can negatively impact their access to the healthcare system.

Purpose: An educational workshop was offered in a local older adult community with the goal of increasing their knowledge, literacy, motivation, and usage of telehealth.

Methods: The participants completed a pre-assessment survey to determine their baseline knowledge, experience, and perceptions about telehealth. They then participated in an educational workshop, which consisted of a 45-minute presentation given via Zoom with a 15-minute …

Utilizing A Toolkit With Individualized Food Label Education For Healthy Food Choices To Reduce The Burden Of Chronic Disease Among Black Americans, Johanna M. Kasidi

Doctor of Nursing Practice (DNP) Projects

Background/Purpose: Black Americans are disproportionately affected by chronic diseases related to diet including hypertension, diabetes, obesity, and stroke when they lack healthy food options and healthy living environments. The purpose of this project was to implement and evaluate the feasibility and effectiveness of a toolkit that primary care providers could use to educate and support Black adults in adopting healthy diet habits to improve overall outcomes and work towards decreasing this disparity.

Methods: This quality improvement project took place at a Community Health Clinic in an urban neighborhood. Participants received nutrition education utilizing a graphic titled “Your Nutrition Facts” …

Improving Lgbtq Provider Competency In The Emergency Department: Guided By Leininger’S Theory Of Transcultural Nursing, Kandyce Casey

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: The lesbian, gay, bisexual, transgender, queer (LGBTQ) population have poorer health outcomes and health disparities due to stigma and discrimination when compared to the general population. The LGBTQ population represents many ethnicities, races, religions, social classes which creates an additional barrier to care. The LGBTQ person has higher rates of being uninsured and therefore healthcare is often delayed, or medical attention is sought in the emergency department (ED) for nonurgent issues.

Purpose: To increase competency of ED providers when caring for the LGBTQ population in the ED by implementing an evidence-based educational program.

Methods: The quality improvement …

Improving Pain Management Of Cognitively Intact Older Adults In Long-Term Care Facilities, Lorraine Howlett

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Pain among residents in long-term care facilities (LTCF) is underrecognized and undertreated. Older adults present a pain management challenge due to their altered pharmacokinetics, pharmacodynamics, multiple morbidities, and polypharmacy. Long-term care facility nurses must be knowledgeable of treatment options, assessment of pain before and after treatment interventions, and how to implement any changes needed as indicated by post-treatment assessment. Barriers such as negative staff attitudes and biases, time constraints, and degree of organizational support may need to be overcome.

Purpose: With increased education, resources, and support, LTCF nurses will be better prepared to provide optimal pain management care …

Increasing Knowledge And Awareness Of Expedited Partner Therapy Among Providers, Angeline K. Motari Mokaya

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: In the past six years, there has been a steady rise in the number of reported cases of chlamydia and gonorrhea in the United States. Expedited partner therapy (EPT) refers to the practice of treating partners of patients diagnosed with specific treatable sexually transmitted infections without first evaluating them. This treatment was recommended by the Centers for Disease Control and Prevention in 2006 and it is currently legalized in 45 states and the District of Columbia. However, many health care providers (HCPs) do not have knowledge of EPT therefore do not make use of it.

Purpose: This quality …

Implementing An Interactive Educational Intervention To Increase Knowledge On Phosphorus Diet And Binder Adherence In Patients Receiving Hemodialysis, Rene Chagnon

Doctor of Nursing Practice (DNP) Projects

Background: Maintaining low serum phosphorus (PO4) levels is recommended in patients receiving hemodialysis through a low phosphorus diet and binder medication compliance, however this remains a struggle for many patients. The literature shows that educational interventions focused on phosphate management can increase patients’ knowledge and improve patient outcomes.

Purpose: To implement an educational intervention focused on low phosphorus diet and adherence to binder regimen to increase patients’ knowledge base, receiving hemodialysis at an outpatient unit at a Veterans Affairs (VA) Hospital.

Methods: An interactive educational intervention involving two 30-minute, one-to-one counseling sessions with educational materials including short videos and a …

Implementing Second Person Reporting In Nurse Practitioner Curricula: A Practical Approach To Person-Centered Care, Collette Tattman-Melo

Doctor of Nursing Practice (DNP) Projects

Background: Nurse handover report inclusive of patient participation has been shown to promote a patient-centered approach to care resulting in increased satisfaction, safety and efficacy. However, a review of the literature suggests the pedagogy of handover report is mainly provided within the “hidden curriculum” of practice, rather than within formal nursing programs. As a result, what constitutes person-centeredness in a handover report is subject to individual interpretation and therefore, practiced inconsistently. Purpose: The project goal was for nurse practitioner students to connect theories of person-centered care (PCC) with practice, specifically by using a tripartite, second-person report (SPR) style. …

Increasing Enrollment Of Cardiac Rehabilitation For Eligible Patients In The Outpatient Setting: A Toolkit, Staci M. Grothues

Doctor of Nursing Practice (DNP) Projects

Background: Heart disease is the leading cause of death worldwide. It is responsible for serious cardiac events that can be fatal. When a patient experiences one cardiac event, they are more likely to have a second event. Therefore, secondary prevention programs such as cardiac rehabilitation (CR) have been proven to reduce mortality in these patients and enhance quality of life; however, they are severely underutilized. Purpose: The purpose of this integrative review and DNP project was to educate outpatient providers about the immense value of cardiac rehabilitation to eligible patients and develop a toolkit targeted to help providers recognize eligible …

Improving Diabetes In The Latino Population: A Culturally Sensitive Approach, Veronica M. Green

Doctor of Nursing Practice (DNP) Projects

Background: Latinos in the United States suffer higher rates of type 2 diabetes (T2D) and need culturally sensitive approaches to diabetes self-management education (DSME).

Purpose: To implement a culturally sensitive DSME program to Latino adults by integrating a community health worker, clinic support, and digital technology.

Methods: This project was implemented over 8 weeks in an internal medicine clinic in El Paso, Texas. It included online DSME group sessions delivered by a community health worker, with primary care support, and key topic reinforcement through text messaging. Concluding hemoglobin A1c levels were drawn and compared with the patient’s baseline hemoglobin A1C …

Telehealth Coaching To Improve Exercise Self-Efficacy In Diabetics, Oby C. Ikoro

Doctor of Nursing Practice (DNP) Projects

Abstract

Background and Review of Literature: Exercise is essential to the self-management of Type 2 Diabetes Mellitus (T2DM). The literature reveals that many patients with difficulty in the self-management of exercise improve with coaching. The literature also reveals that an adequate exercise routine results in improved blood glucose control and the prevention of complications.

Purpose: This DNP project aims to demonstrate the positive effect of low-cost telehealth coaching to improve self-efficacy in an exercise regimen for T2DM patients.

Methods: A one-group pretest-posttest design was used in this project. Telephone calls and text messaging were used to coach patients to improve …

An Educational Intervention For New Graduate Nurses To Improve Care For The Hospitalized Patient With Diabetes, Elizabeth Tinios

Doctor of Nursing Practice (DNP) Projects

Background: Approximately one in three hospitalized patients have a diagnosis of Diabetes Mellitus (DM) that requires the high-risk medication insulin in order to maintain blood sugar control. The prevalence of insulin-related medication errors leading to hyper- and hypoglycemic reactions persists despite numerous interventions focused on provider prescriptive practice.

Purpose: This project provides evidence-based education to a cohort of new graduate nurses to increase nursing knowledge of safe insulin administration as well as raise awareness of comprehensive diabetes care.

Methods: The Iowa Model Revised guided this project through implementation of a live educational session provided through a video conference …

An Educational Approach For Improving Prediabetes Awareness And Management Among Asian Americans, Sheeba S. Thattil

Doctor of Nursing Practice (DNP) Projects

Background: South Asian Americans have a high prevalence of prediabetes due to their dietary habits, physical activity changes, and lifestyle variations. The literature review depicts the evidence that community-based educational programs improve knowledge and lifestyle behaviors to prevent diabetes.

Purpose: This Doctor of Nursing Practice (DNP) project focuses on implementing a culturally tailored education approach that helps manage prediabetes by changing their lifestyle behaviors among South Asian immigrants living in Maryland.

Methods: The Health Belief Model (HBM) was used as the theoretical framework. A prediabetes screening test from CDC was used to recruit fourteen participants aged 18-60 from a South …

Geographical Disparity Of Adverse Childhood Experiences And Chronic Diseases In Saudi Arabia, Fahad Alhowaymel

Doctoral Dissertations

Background: Adverse childhood experiences (ACEs) have been linked to numerous negative physical and mental health outcomes and have been shown to increase risk for chronic diseases in adulthood. In Saudi Arabia, few studies have examined ACEs prevalence and their relation to chronic diseases across geographical settings. Purpose: The purpose of this study was to examine ACEs prevalence and association with chronic diseases across the provinces of Saudi Arabia, and to determine the moderating effect of geographical setting on the ACE-chronic disease relationship. Methods: A cross-sectional design was used with an existing Saudi national dataset from the National Family Safety Program …

Improving Cultural Competency Among Healthcare Providers Working With Refugee Patients, Tena Chau

Doctor of Nursing Practice (DNP) Projects

Background: Increased diversity of the United States population has resulted in the presence of greater disparities in healthcare. One way to address factors contributing to health disparities has been to increase cultural competency in healthcare. Evidence from a review of the literature supports the idea that understanding aspects of cultural competency that are lacking among specific healthcare organizations are helpful to develop programs to address the areas of need. Purpose: The purpose was to complete a quality improvement project to evaluate if an educational intervention based on a specific model would lead to increased level of cultural competence among healthcare …

In Beers We Trust: Using Deprescribing Tools To Reduce Inappropriate Polypharmacy In Adults Age ≥ 65, Angelica Ferrazzi

Doctor of Nursing Practice (DNP) Projects

Background: Adverse drug events (ADEs) are a significant cause of morbidity and mortality in older adults (age ≥ 65). Polypharmacy and potentially inappropriate medications (PIMs) are especially prevalent in this population and are a notable contributing risk factor for ADEs. Research demonstrates that comprehensive medication reconciliation that includes evaluation of both the risks and benefits of medications, in conjunction with deprescribing practices, can reduce PIMs; therefore, reducing ADEs.

Purpose: The aim of this quality improvement project was to empower clinicians to deprescribe current medications that are inappropriate, as well as reduce the rate of newly prescribed PIMs among patients age …

Adolescent Mental Health Training For Middle School Educators, Sarah Minton

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Adolescent mental health disorders are an increasing concern in the United States. School systems, specifically educators, are in the unique role to aid in early identification of mental health disorders, as well to intervene in mental health distress. However, mental health training for educators is lacking, leaving educators unprepared to manage mental health concerns within their classroom.

Purpose: The purpose was to utilize an evidence-based training, the “Teacher Knowledge Update Guide” from TeenMentalHealth.org to train middle school educators on the signs and symptoms of mental health conditions in the adolescent population with the intent to increase awareness, knowledge, …

Increasing Staff Knowledge And Screening Practices For Adverse Childhood Experiences In Primary Care, Angela Mcgraw

Doctor of Nursing Practice (DNP) Projects

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened …

Utilizing Motivational Interviewing To Encourage Weight Loss In Primary Care, Wendy Sergeant

Doctor of Nursing Practice (DNP) Projects

Purpose and Background: The purpose of this project was to educate nurse practitioners (NPs) and nurses (RNs) to promote healthy changes in obese individuals using the principles of Motivational interviewing (MI). Obesity is a growing epidemic in the United States with two out of every three adults considered overweight or obese. Their health problems become costly and deadly. Ideally, RNs and NPs are the front line providers in this struggle of obesity because of their philosophy of health promotion. RNs and NPs can screen and address obesity through lifestyle counseling. Motivational interviewing, a proven and effective counseling method, is useful …

Mitigating Prescription Opioid Risk: Prescription Drug Monitoring Programs, Brenda Vigue

Doctor of Nursing Practice (DNP) Projects

Background: Opioid-related morbidity and mortality is a serious public health issue in the United States. Prescription Drug Monitoring Program (PDMP) review prior to prescribing opioids has consistently been recommended as best practices for risk mitigation, however, access/utilization of this monitoring program remains low.

Methods: This quality improvement (QI) project for improved PDMP utilization employed a pre-post survey design in a random sample of Advanced Practice Registered Nurses in Arizona. Quantitative measures included online surveys with close-ended responses to salient items from the review of literature and best practices. A follow-up survey was requested of the participants who provided their …

Program Evaluation Of An Easy Access Clinic For Effective Contraception For U.S. Active Duty Women In Okinawa, Japan, Cynthia Kuehner

Doctor of Nursing Practice (DNP) Projects

Background: Unintended pregnancy in the United States (U.S.) is a significant health problem that takes on additional magnitude in the context of military service. Young, active duty women have higher unintended pregnancy rates compared to the general population, secondary to non-use of contraception or selection and use of the least effective methods (condoms and oral contraceptive pills). The literature validates the problem, identifies access barriers to highest-efficacy contraception options in primary care settings, and offers evidence-based, best practice opportunities to impact this public health challenge.

Purpose: The purpose of this project was to evaluate access, utilization, effectiveness, and patient satisfaction …

Promoting Sleep Health Through Identification And Management Of Obstructive Sleep Apnea, Melissa Vuolo

Doctor of Nursing Practice (DNP) Projects

Background: There is a high prevalence of obstructive sleep apnea in the United States, which left untreated can lead to increased cardiovascular risk. The current practice standard is to use a questionnaire to evaluate a patients’ sleep health, but this is not done regularly in every clinical setting. This DNP project aimed to bridge the gap in practice by implementing regular screening of obstructive sleep apnea in an urgent care center in Massachusetts.

Methods: This DNP project was conducted by having adult patients complete the Epworth Sleepiness Scale to determine the presence of a sleep health issue. The patients …

“Tell Me A Story®”: Promoting Resiliency In Military Children, Katherine-Marie Conover

Doctoral Dissertations

Multiple and lengthy deployments of military members are common and negatively impact children’s well-being. Programs seek to increase resiliency and reduce potential negative impact of parental deployment on children exist but lack empirical evidence to support their effectiveness. Increased parent engagement through reading and subsequent discussion with their children has positive psychology implications and potential to improve resilience. Thus, this study’s purpose was to examine the effectiveness of the intervention Tell Me A Story® (TMAS) in improving resiliency in school-age children (aged 6 to 10 years) of active duty military members. This study also aims to examine the impact of …

Hepatitis C Virus Education For Nurse Practitioners In Primary Care, Michele Broskey

Doctor of Nursing Practice (DNP) Projects

Purpose: The object of this Quality Improvement (QI) project was to appraise the effectiveness of a web-based education resource for APN’s knowledge of HCV recommendations.

Methods: An educational intervention was conducted for APNs working in primary care medicine to increase provider knowledge of screening, diagnosing and management of viral Hepatitis C which utilized a web-based provider-specific curricula. A pre-test and post-test survey was used to assess the APN’s Knowledge, Attitude and Practices (KAP) regarding the current published evidence. Continuing education credits and small financial incentives were offered for participation. The curriculum was evaluated by an Infectious Disease expert APN.

Results: …