Family Practice Nursing Commons^™

Evaluating An Employee Health Tobacco Cessation Program For Enhanced Success, Leah Griffiths, Kathy S. James

Doctor of Nursing Practice Final Manuscripts

Tobacco smoking is the number one cause of preventable death in the US. It increases risk for cardiovascular and respiratory disease, diabetes, and many types of cancer. When contrasted with nonsmoking employees, smokers have a greater amount of lost productivity, as well as cost of health and life insurance claims due to illness. The purpose of this evidence-based project was to identify current smokers and monitor the consistency of their progression through the 5 A’s framework within an employee health clinic. Data was collected over two years and 600 charts were reviewed. After the data was analyzed, it was estimated …

Prevalence Of Binge Eating Disorder In An Insurance-Based Weight Management Center, Kimberly M. Kittleson Dnp, Fnp, Karen Macauley Phd, Dnp, Fnp-Bc, Gnp-Bc

Doctor of Nursing Practice Final Manuscripts

Purpose: This project was anticipated to demonstrate an increase in the number of those diagnosed with BED according to Diagnostic and Statistical Manual (DSM) 5 criteria, diagnosed with ICD-10 code F50.8 or R63.2 and treated according to best practice guidelines.

Background: Binge eating disorder (BED) is the most common eating disorder in the United States, more than both anorexia and bulimia combined. It affects 3.5 percent of women, 2 percent of men and 30 percent of those seeking weight management.

Design: This evidenced-based project consisted of a retrospective analysis of 150 patients seen in a weight management …

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 …

Diabetes Self-Management Education (Dsme) Program For Glycemic Control, Jenilyn P. Peros

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this quality improvement project was to implement and evaluate the impact of Diabetes Self-Management Education (DSME) program with type 2 diabetes mellitus (DM) patients. The goals were to improve glycosylated hemoglobin (A1C) and improve patient satisfaction.

Methods: A quality improvement project using the Iowa model was implemented in a primary care setting in Southern California to provide DSME program for adults with type 2 diabetes. A nurse practitioner conducted three DSME group sessions, which were done for 90 minutes per session in a 4-month period. The American Association of Diabetes Educators (AADE) 7 self-care behavior …

Stress Management In A Corporate Setting, Erinn Gelakoska, Susan Instone

Doctor of Nursing Practice Final Manuscripts

Abstract

The purpose of this evidence-based project was to implement a sustainable stress management program in a corporate setting, utilizing company stress management resources. A three-step program was initiated to include a 30-minute stress education session, followed by a 30-minute one-on-one session with a nurse practitioner student utilizing aspects of motivational interviewing to develop a goal oriented stress management plan. An individual one-month follow up was also performed. Of the 30 employees who attended the educational session, 15 signed up for a one-on-one session. Eight out of the 15 employees completed the one-month follow up. Employees completed a pre and …

Implementing The 5as Framework For Obesity Management, Jennifer C. Sassman

Doctor of Nursing Practice Final Manuscripts

This Doctor of Nursing Practice (DNP) pilot project strives to improve management of obesity by increasing provider knowledge and utilization of the 5As Framework which is an effective evidence-based intervention and a behavioral counseling tool. Pre-data including BMI and waist circumference were collected over one month. An educational in-service on the 5As was held for one primary care nurse practitioner. Post data was gathered over five months. Provider knowledge on the 5As was increased however, there was not an increase in identifying obesity. The 5As was used about 10% of time with obese patients. This pilot project can be expanded …

Improving Asthma Symptoms Using Asthma Action Plans, Ryan Daniel Thebo, Michael Terry

Doctor of Nursing Practice Final Manuscripts

Asthma is a chronic disorder characterized by airflow obstruction, causing chest tightness, wheezing, coughing, and shortness of breath. In California, 7.9% of patients have an asthma diagnosis. The 2007 NHLBI Expert Panel Report 3 recommended using asthma action plans in asthma management (NHLBI, 2007). Patients with asthma were taught to use an AAP to improve asthma control. Overall, 80% of patients improved by at least one EPR3 asthma control category.

Wecan Implementation For Parents Of At-Risk Hispanic Adolescents In Middle School, Shannon Leigh Devita

Doctor of Nursing Practice Final Manuscripts

Abstract

CDC-reported childhood obesity rates have tripled in the past three years. Among children in grades five, seven and nine, 30% are overweight or obese, with Hispanic students more likely to be overweight than White students. This evidence-based project examined the effectiveness of NHLBI’s WeCan! for at-risk middle-school-age Hispanic children and parents. The program was implemented at school in two weekly sessions, and its effectiveness was evaluated using the WeCan! survey. The program resulted in improved knowledge, behaviors, and attitudes related energy balance, portion size, healthy foods, physical activity, and screen time and may be useful in other school settings.

Improving Utilization Of 2012 Asccp Guidelines In A Family Practice Setting, Michelle M. Mccormick, Mary Barger

Doctor of Nursing Practice Final Manuscripts

The purpose of this evidence-based project is to decrease unnecessary colposcopy referrals using provider education and user friendly tools. This is accomplished by increasing utilization of the 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) Guidelines at a Military Treatment Facility Family Practice Clinic. Despite clear cervical cancer screening guidelines, nationwide, women are continuing to have unnecessary Pap testing regardless of HPV status. Over screening can result in an increase in false positive results, leading to rising healthcare costs, additional office visits, and stress to the patient from procedures that yield little useful information or decrease in morbidity. Although …

Improving Hpv Vaccinations In Military Women, Sarah Beth Wedel

Doctor of Nursing Practice Final Manuscripts

Project Purpose: The purpose of the project was to implement Human Papillomavirus (HPV) patient education during every well woman exam (WWE) to improve patient knowledge and HPV vaccination rates in military women aged 18-26 years.

Background: The Human Papillomavirus (HPV) has been identified as the biggest risk factor for cervical cancer and, despite the availability of a vaccine; HPV continues to be the most common STI in the U. S. (American Cancer Society, 2013). Approximately 79 million Americans are currently infected with HPV, and 14 million individuals will become infected annually, leading to more than 10,000 cases of cervical cancer …

Promoting Completion Of Advance Directives In A Hispanic Religious Congregation: An Evidence-Based Practice Project, Luis Daniel San Miguel, Mary Jo Clark

Doctor of Nursing Practice Final Manuscripts

Background: Hispanics utilize more aggressive medical treatment at the end of life and are less likely to receive end-of-life care consistent with their wishes than nonHispanic Whites. Hispanics are less likely than nonHispanic Whites to have an advance directive (AD). Increasing AD completion among Hispanics can promote end-of-life care consistent with their wishes, diminish healthcare disparities, and eliminate unnecessary healthcare spending. Objectives: To promote completion of advance directives by increasing knowledge, positive attitudes, and comfort with advance care planning (ACP) among Hispanics through culturally sensitive interventions. Intervention: The project was conducted in Spanish and implemented among a …

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 …

Supporting Self-Management In Veterans With Chronic Pain: A Policy Perspective, Erin W. Lind

Doctor of Nursing Practice Final Manuscripts

The purpose of the project was to do an evidence-based review of the effectiveness of promoting self-care on pain levels and quality of life among veterans with chronic pain at a national level. A review of current chronic pain management policies for veterans in southern California was also conducted. Active self-management initiatives permit more diverse, patient-centered treatment, promote self-management, and are relatively safe and cost-effective. Our results have confirmed that chronic pain is on the forefront of priorities for the Veterans Health Administration (VHA) due to an increasing rate of both chronic pain and opioid overdoses.

Diabetic Prevention The Hard Way: Modified Diet And Increased Exercise, Torrie Reese St.Julien

Doctor of Nursing Practice Final Manuscripts

Background and Purpose: In the United States, 79 million people are pre-diabetic: most have no symptoms. If left untreated, 37% will develop diabetes within 4 years. Fourteen percent of United States health care expenditures are related to diabetic complications. This Evidenced Based Project (EBP) involved a behavioral lifestyle change with the purpose of 7% weight loss and a minimum of 150 minutes of physical activity a week. It was also designed to reduce risk factors and glycated hemoglobin A1c (HgA1c) levels.

Methods: The interventional approach was modeled after the Diabetes Prevention Program (DPP) and Group Lifestyle Balance Program. Participants were …

Heart Failure Patient Self-Care: An Evidence-Based Outpatient Management Program, Christine Marie Ensign, Shelley Hawkins, Barry Greenberg

Doctor of Nursing Practice Final Manuscripts

Background: According to the American Heart Association, there are over 5 million people in the United States with heart failure (HF) and projections suggest the prevalence of HF will increase by 46% through 2030. HF is the most common cause of hospital admissions in the United States for patients age 65 years or older and despite improvement outcomes, national readmission rates remain high at 23%. Current guidelines recommend health professionals provide comprehensive HF education and counseling that is not only focused on knowledge, but also on skills of management and self-care behaviors. In order to achieve quality patient-centered care, …

Transitional Care Of Adult Patients With Diabetes Following Hospitalizations, Eric Tobin

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based practice project was to incorporate a diabetes transitional care program using group visits to improve self-care management behaviors and glycemic control in diabetic patients at a southern California hospital.

Background: Diabetes is a challenging healthcare problem associated with significant mortality and morbidity issues. In 2012, 29.1 million people, or 9.3% of the U.S. population, were diagnosed with diabetes, and 28.9 million of those patients were 20 years of age and older. Today, diabetes is of epidemic proportion worldwide, and a projection of 5.4% of the adult population will have diabetes by 2025. The …

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 …