Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

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 …

Integrating Culturally Tailored Interventions To Increase Cervical Cancer Screening: A Quality Improvement Initiative In A Primary Care Clinic, Marife Centeno Solomon

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: While the incidence of cervical cancer in the US has significantly decreased due to the utilization of vaccination and screening tests, Asian, Native Hawaiian, and other Pacific Islander women consistently have the lowest rate of cervical cancer screening, making them at risk for undetected cervical cancer disease.

Problem: The low cervical cancer screening uptake can be attributed to a knowledge deficit about cervical cancer and its screening and the importance of early detection. Being an immigrant and with limited English proficiency can hinder women of Asian, Native Hawaiian, and other Pacific Islander from getting screened for cervical …

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 …

Manager Onboarding To Improve Knowledge And Confidence To Lead, Christine (Tina) K. Asiimwe

Doctor of Nursing Practice (DNP) Projects

Background: Primary care (PC) is increasingly the setting for affordable, coordinated, end-to-end patient care, with PC managers in charge of organizational performance. While PC managers are central to high-functioning teams, they often receive inadequate onboarding.

Local Problem: Primary care onboarding competes with other operational priorities and faces time constraints, lack of mentorship, and cost.

Context: At an integrated healthcare system, a need was identified to develop structured, role-specific onboarding for newly hired PC managers to improve knowledge and confidence to lead.

Interventions: Bauer’s Four Cs framework for onboarding guided the development of a manager onboarding program for 12 new PC …

Mindfulness-Based Cognitive Therapy Staff Training Program To Tackle Postpartum Depression, Helen Xumin Chen

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Women in the process of childbirth go through significant physical and psychological changes. The internal changes along with other external factors can be overwhelming. There is a high rate of new mothers suffering from postpartum depression (PPD) as a result. Problem: High prevalence of PPD is a public health crisis. The condition has a negative impact on the mother-baby unit and the wellbeing of the whole family. Aside from the implications on the health of new mothers and babies, PPD is also costly to the economy. Methods: Mindfulness-Based Cognitive Therapy (MBCT) is a common and effective intervention for …

Utilizing A Stress And Coping Model Into A Preventive Abusive Head Trauma Parent/Caregiver Educational Program, Camile Williams

Doctor of Nursing Practice (DNP) Projects

Abusive head trauma (AHT) is a serious form of child maltreatment that is the primary cause of fatal head injuries in children younger than 24 months and is the cause for over 50% of severe or fatal traumatic brain injury incidences. These injuries can be caused by impact, shaking, or the combination of shaking and impact. These multi-factorial injuries can cause intracranial and spinal damage, retinal hemorrhages, and fractures of ribs and other bones. The age and severity of injuries will be used to assess the diagnosis of AHT. When AHT occurs, it is often tied to the behavior from …

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 …

Increasing Access To Medicare Annual Wellness Visits In Primary Care; Utilizing Registered Nurses As Part Of An Interdisciplinary Team Based Approach, Iyo Kubota

Doctor of Nursing Practice (DNP) Projects

Background: In order to provide evidence-based preventive care to the aging population, Medicare began providing free annual wellness visits (AWVs) to its beneficiaries in 2011. The AWVs are a great opportunity for primary care providers to develop personalized preventive care as well as health promotion. However, many primary care practices especially those with limited resources struggle to incorporate AWVs into their busy primary care practice. Centers for Medicare and Medicaid Services allows other providers than physicians, NPs and PAs to perform those visits including registered nurses, health educators, and registered dietitians.

Methods: A pilot project was conducted with 12 patients …

Initiating Prep In Primary Care: Addressing The Adolescent And Young Adult High Risk Populations, Igor G. Mocorro

Doctor of Nursing Practice (DNP) Projects

Problem: Adolescents and young adults (AYA) ages 13 to 24 comprise a quarter of the new HIV diagnoses in the United States. Lack of access to HIV-preventive therapies such as pre-exposure prophylaxis (PrEP) reduces opportunities to prevent HIV infection in this population. Initiating PrEP in AYA significantly reduces the negative health outcomes of HIV, but it is evident that many clinicians are still reluctant to initiate PrEP in AYA patients based on perceived threats and barriers.

Context: Primary care clinics, including school-based clinics, have an opportunity to offer HIV prevention services including PrEP. This project, the Adolescent and Young Adult …

Wound Care Education For Primary Care Providers At A Regional Medical Center, Zaira Torres

Doctor of Nursing Practice (DNP) Projects

Problem. Due to the aging population and the high prevalence of chronic diseases such as diabetes and cardiovascular disease, in the US, millions of people suffer from chronic wounds secondary to these chronic conditions. Wound care treatment is very expensive, costing the US health care system approximately $10 billion annually. San Mateo Medical Center treats many patients with wounds. However, the treatment is suboptimal as most primary care providers (PCPs) are not trained to perform wound care according to best practice. This creates several problems such as a large number of referrals to the Vascular Clinic, visits to the emergency …

Unaddressed Challenges For The “Most Honest And Ethical Profession:” A Pilot Study Of Web-Based Learning Strategies To Prevent Moral Distress, Kelly Straight

Doctor of Nursing Practice (DNP) Projects

Background: Nurses and nurse practitioners (NPs) face greater responsibility to address the ethical challenges that present during the course of patient care, due to advances in medical technology and pharmaceutical innovation, and because of widening disparities within the U.S. healthcare system. These ethical questions, which arise during the course of routine patient care, are increasing in both number and complexity in nearly every patient care setting. Even with codified ethical standards, unresolved and/or ongoing ethical questions and dilemmas pose further issues such as the development of moral distress. This pilot project was designed to help NPs and other healthcare workers …

Technology-Based End-Of-Life Planning For An Underserved Population, Haley Kirkpatrick

Doctor of Nursing Practice (DNP) Projects

Problem: Research indicates a low-income status and ethnic and racial diversity is a barrier to ACP engagement.

Context: This project took place at a Federally Qualified Heath Center located in Northern California which serves approximately 200,000 diverse and economically disadvantaged patients.

Methods: The primary intervention was dissemination of an email to patients 50 and older, via their health system email account. The email included a direct link to PREPARE, an online advance care planning technology tool. A secondary intervention was a presentation to primary care providers that focused on end-of-life-care planning tools and communication strategies.

Results: The email was distributed …