Addressing Social Determinants Of Health In Medication-Assisted Treatment Programs, Audrey Hunter

The Eleanor Mann School of Nursing Student Works

ntroduction: Medication-assisted treatment (MAT) is considered the most effective treatment for patients with opioid use disorder (OUD); however, MAT program retention rates are consistently low across the United States. Addressing social determinants of health (SDOH) through text message could impact MAT retention; therefore, a pilot project at a federally qualified healthcare center (FQHC) was implemented.

Methods: The Protocol for Responding to and Assessing Patients’ Assets, Risk, and Experiences (PRAPARE) SDOH screening tool was implemented for patients undergoing MAT for OUD. Community resource referrals were provided via text message based on the screening results. Retention in treatment was measured by prescriptions …

Referral To In-Person Smoking Cessation Counseling As A Smoking Cessation Aid, Annie Mandrell Bsn, Rn, Matthew Keathley Bsn, Rn, Lewis Linden Bsn, Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid

Purpose/Background

Smoking increases an individual’s risk of acute and chronic disease morbidity and mortality, as well as creating a financial burden for the individual and healthcare system. In the United States, tobacco smoking is the leading cause of preventable death. There are an estimated 5 million tobacco-related deaths each year due to tobacco smoking. Additional healthcare costs are also seen due to the need for increased treatments, medical supplies, and staffing. Previous research for smoking cessation resources has primarily focused on traditional primary care offices. Research shows that in-person …

The Effect Of Continuous Glucose Monitoring On Glucose Control And Re-Hospitalizations In Type Ii Diabetes Mellitus Patients, Susan Ferguson

The Eleanor Mann School of Nursing Student Works

Purpose: This Program Development and Evaluation project was designed to improve the management of patients with type II diabetes mellitus through the implementation of a combined in-patient discharge protocol and outpatient continuous glucose monitoring protocol follow-up plan in a diabetes clinic following discharge from a rural-based acute facility hospitalization.

Method: This quasi-experimental project was based on Rosswurm and Larrabee's Model for Change framework. Outcome measures analyzed type II diabetes mellitus patients to assess the effects of a continuous glucose monitoring discharge protocol on pre- and post-glycemic levels, rehospitalizations, and patient (n=2) and provider knowledge (n=4) obtainment.

Results: In a comparison …

Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

The Case For Crisaborole, Chelsea Carnes

MSN Capstone Projects

To begin, topical corticosteroids (TCS) have been the standard first-line treatment medication for atopic dermatitis (AD) since the Federal Drug Administration (FDA) approved them in 1955 (Siegfried et al., 2016). Given that evidence-based practice (EBP) usually changes every few years for many other issues, that is a long period of time. This long-standing standard unfortunately leads many clinicians to the classic “we have always done it this way” conclusion. However, with scientific advancement, there are many more treatments available for AD today. One that is particularly promising is crisaborole, which is currently available under the brand name Eucrisa.

This medication …

Evidenced-Based Strategies To Increase Cervical Cancer Screening Rates, Tuong Cat Vo Bsn-Rn, Nada Salloukh Bsn-Rn, Tatiana Elena Swanson Bsn-Rn, Xiao Mie Cindy Zhu Bsn-Rn, Laura Taylor Reed Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Cervical cancer is the fourth leading cause of cancer affecting women worldwide (Staley et al., 2021). With cervical cancer being a preventable disease, an effective method of reducing healthcare costs and mortality is primary prevention, such as screenings. Financial burdens and barriers to accessing medical care may result due to the lack of proper cervical cancer screenings. Detecting cervical cancer includes screening women 21 to 65 years old with a Papanicolaou (PAP) test every three years. Women aged 30 to 65 years old can extend the screening of cervical cancer by having a Human Papillomavirus (HPV) test along with …

Initiating Culturally-Directed Education For Hispanic Adults With Type 2 Diabetes Mellitus, Marie Davis, Jennifer Smith, Mandy Horner

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND:

The U.S. Hispanic population has the highest rate of Type 2 diabetes mellitus (T2DM), which is influenced by socio-economic status and language barriers. Current evidence suggests that the delivery of culturally-directed Diabetes Self-Management Education (DSME) with the use of an interpreter can reduce diabetes-associated complications.

LOCAL PROBLEM:

The project took place at a free clinic in North Carolina. The purposes of this project was to create a culturally-directed DSME bundle for Hispanic adults with the use of a Spanish interpreter to improve understanding of T2DM management.

METHODS:

The Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was …

Antibiotic Stewardship In Patients With Viral Upper Respiratory Illness: Improving Quality Measures In Retail Health, Meredith A. Nolan, Robin Harris, Clay Smith

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Millions of people will die from antibiotic-resistant bacterial infections in the next 30 years. Retail health providers are pivotal in this global epidemiological problem.

LOCAL PROBLEM: Setting included 15 retail health clinics operated by Vanderbilt University Medical Center in Middle Tennessee. Project examined provider education, patient engagement, and commitment to antibiotic stewardship, components of the CDC's Core Elements of Outpatient Antibiotic Stewardship framework. Specific aims were that providers would have a significant reduction in the percentage of antibiotics prescribed for viral illness over the study period.

METHODS: Using the Evidence-Based Practice Improvement Model, a Quality Improvement …

Reducing Copd Readmissions Through The Implementation Of A Guideline-Based Clinical Pathway: An Evidence-Based Practice Improvement Project, Hannah F. Hall, Allyson Neal, Samantha Bauer

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death worldwide. It is characterized by airway inflammation and damage that inhibits appropriate airflow. Exacerbations of COPD (ECOPD) hasten disease progression and have profound impacts on the patients.

Local Problem: East Tennesseans experience higher rates of COPD than the rest of the state. Community members at the project site identified that the inpatient management of ECOPD is inconsistent and discordant with the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. The purpose of this project was to reduce readmissions and increase guideline concordance by developing an algorithm …

A Patient Centered Quality Improvement Education Program Designed To Improve The Health Of Patients Living With Uncontrolled Hypertension In A Primary Care Setting, Alia Jamison-Dinowitz

Doctor of Nursing Practice Projects

Cardiovascular disease is the leading cause of death in the United States and it negatively contributes to poor health outcomes (Martinez-Garcia et al., 2018). Within the Antelope Valley in Lancaster California, 30.3 % of city residents have a hypertension diagnosis (Los Angeles County of Public Health, 2017). Much like the city at large, hypertension is a critical issue at AV Pediatrics and Family Medicine (AV Peds). This issue is driven by a variety of factors including a lack of understanding about hypertension and medication compliance, and a lack of understanding about healthy lifestyle choices. Providers at AV Peds have seen …

Impact Of Processed Food On Heart Health, Elizabeth Moxley

Faculty Peer-Reviewed Publications

Impact of Processed Food on Heart Health

March 14, 2024|Elizabeth Moxley

Cardiovascular disease (CVD), particularly atherosclerotic cardiovascular disease (ASCVD), remains the leading cause of death on a global scale.^[i],[ii] CVD is also the leading cause of death in patients with type 2 diabetes (T2D), specifically in low- and middle-income countries.^[iii] In spite of the improvement in ASCVD outcomes in recent decades, pervasive levels of ASCVD morbidity and mortality continue to be unfavorable.^[iv] According to the American Heart Association,⁵ effectively promoting dietary improvements and engagement in regular physical activity help prevent the ongoing risk …

The Effectiveness Of Annual Mammograms Versus Triennial Mammograms In Women Under The Age Of 50, Jordyn A. Gowell, Dakota Grace Cochran, Ashley Cantwell, Sara Doughty, Allison Sgrosso

Non-Thesis Student Work

The current recommendation for mammography frequency is every 2 years after age 50. However, newer data shows that yearly mammograms are effective in early detection of breast cancer, even before age 50. These authors posed the question: In women under age 50, is a yearly mammogram more effective than a mammogram every 3 years in detecting breast cancer? A literature search was conducted on CINAHL, MEDLINE, Google Scholar and Cochrane Library using the following terms: mammography, mammogram, annual, yearly, every three years, triennial, and breast cancer. A total of 10 articles met the inclusion criteria. The results of the literature …

Distraction Interventions And Play Therapy: Decreasing Fear And Anxiety In Hospitalized Patients Less Than 12 Years, Terence J. Olds, Jordan Conroy, Rebecca Rider, Julia Good, Hannah Peacock

Non-Thesis Student Work

Hospitalization can be a frightening experience for pediatric patients. Addressing these negative emotions greatly impacts their experience, wellbeing, and recovery process. It is crucial to understand and implement strategies that alleviate these negative emotions and promote healing during hospitalization. The authors will review two safe, effective, and reliable methods of alleviating fear and anxiety in hospitalized children under 12 years old; distraction techniques and play therapy. A literature search was conducted on CINAHL and PubMed using the following search criteria: child, youth, kid, play therapy, therapeutic play, anxiety disorders, generalized anxiety, hospital, acute setting, inpatient, and distraction. A total of …

Increasing Annual Depression Screening For Adults In A Primary Care Setting, Sandy Zachery, Sheryl Winn, Flor Culpa-Bondal

Graduate Research Showcase

Increasing Annual Depression Screening for Adults in a Primary Care Setting

Background:

Depression is a mental illness that's common worldwide, which can cause an individual to function poorly in society and can progress to suicide. Because of several barriers, patients in a primary care environment are not being seen or treated for depression. Even though the U.S. Preventive Services Task Force (USPSTF) recommends that all adults in primary care receive annual depression screening that delivers effective treatment with the correct diagnosis and accurate follow-up, patients are still not being screened for depression.

Purpose:.

This project aims to improve …

The Implementation Of Nurse Practitioner Residency Programs To Increase The Employment Retention Of New Graduates, Roni-Jo Panganiban

Master of Science in Nursing Family Nurse Practitioner

This review explores the effectiveness of Nurse Practitioner (NP) residency programs in addressing role strain, burnout, and retaining new graduates. It emphasizes the factors contributing to NP resignations and proposes formal residency programs to improve job satisfaction and retention rates. Research highlights benefits such as enhanced preparedness, credibility, and better patient care, advocating for increased program accessibility and funding. Additionally, the application of the theory of planned behavior underscores compliance with regulations, evidence-based practice, and environmental influences for patient safety in advanced practice registered nursing. The literature review on NP residency programs draws from six empirical articles, focusing on job …

Cardio-Pulmonary Resuscitation Without The Pulmonary? A Benchmark Project, Fernando A. Rios

MSN Capstone Projects

Cardiac Arrest occurs outside of the hospital setting more than you think. According to MyCares.net, 15% of OHCA happened in a public setting in 2020. Even if you are a trained healthcare professional, it may not be accessible at times in these situations due to different factors such as equipment availability, trained assistance, etc... Having an alternative option to conventional mouth-to-mouth rescue breath CPR would encourage trained and untrained bystanders to perform life-saving interventions to patients until local EMS responders can arrive. The covid pandemic affected everyone inside and outside the medical world. The general population got a real …

Green Tea Supplementation: An Effective Lifestyle Modification For Cholesterol Management, Samuel J. Nemati

MSN Capstone Projects

Hypercholesterolemia is an insidious disease and the leading factor to the deadliest killer in the United States – cardiovascular disease (Centers for Disease Control and Prevention, 2023a). Over 85 million American adults suffer from elevated cholesterol, and treatment can prove challenging and may require multiple modalities outside just pharmaceutical intervention – such as dietary and other lifestyle changes (Centers for Disease Control and Prevention, 2023b; Goldman, 2023). Green tea – among the most common teas consumed worldwide – exerts a uniquely antihyperlipidemic and cardioprotective effect that suggests its consideration as a potentially-viable nonpharmacological option for hypercholesterolemia (Harvard Health Publishing, 2012; …

The Effects Of Education On Influenza Vaccination Uptake, Jazzlyn Lawson

MSN Capstone Projects

Influenza is a viral illness that occurs internationally and peaks in prevalence during the months of October to May. There are several types of influenza viruses: Influenza A, B, C, and D (CDC, 2023). Vaccines are available in the United States as early as the start of the flu season to those who wish to receive it. The influenza virus types covered by the annual flu vaccine include Influenzas A and B types (CDC, 2023). The influenza vaccine is recommended by the CDC with the intent to limit the occurrence and spread of influenza each year. Symptoms of influenza consist …

A Systematic Review Of The Effect Of Family-Centered Education On The Physical And Mental Health Of Middle Eastern Refugee Women, Holly Keylada, Debora Merheb, Emilia Folkerts, Julia Nix, Khloe Blakey, Kimberly Landrum, Cheryl Swanson

Nursing Undergraduate Work

Refugee women from the Middle East are underrepresented in research and meeting their physical and mental health needs remains a significant challenge for healthcare workers in countries of resettlement. In this systematic research review, we synthesize family- centered interventions to address mental, menstrual, and reproductive health within this population. Twenty-one relevant studies were identified, showing the benefits of providing culturally sensitive family-centered education through the integration of educational interventions focused on community outreaches, interpersonal relations, school-based education, social networks, and more. However, there is still a need for high-quality mental, reproductive, and menstrual intervention studies within resettled refugees from the …

Body Dysmorphia Screening Tool For Aesthetic Treatments, Brandi Harper

MSN Capstone Projects

This evidence-based project includes a discussion of Body Dysmorphic Disorder (BDD) or body image disturbance as part of pre-treatment screening in medical facilities providing appearance-altering procedures and aesthetic treatments to adult patients. The information provided serves as the foundation for endorsing the adoption of a BDD screening tool into clinical practice to increase the identification of body dysmorphia, thereby facilitating proper referral, diagnosis, and treatment to aid in patient safety and satisfaction and limit medico-legal imputations. The discussion presented here is supported by evidence-based research. It focuses on BDD prevalence and significance amongst adult patients and highlights validated screening tools …

The Effect Of Obesity On Comorbidities: A Benchmark Study, Kaley Nolen

MSN Capstone Projects

Obesity is distinguished by a body mass index (BMI) greater than 30. Tremmel et al. (2017) reports obese individuals are at a greater risk for developing cardiovascular disease, diabetes, and cancer. In 2014, approximately 641 million adults were classified as obese (Zhang et al., 2018). This epidemic has drastically worsened over the last two decades resulting in obesity ranking as the fifth most common cause of death globally (Safaei et al., 2021). Okunogbe et al. (2021) states, slowing the incidence rate of obesity by 5% will save approximately $3.3 billion annually between 2020-2060. The pathophysiology and cause of obesity is …

Role Of Hand Hygiene In The Prevention Of Central Line-Associated Bloodstream Infection In Intensive Care Unit Patients: A Benchmark Project, Meliana Amazan

MSN Capstone Projects

CLABSI (Central Line Associated Blood Stream Infection) is one of the most common hospital-acquired infections in the ICUs (Intensive Care Unit). Not only it is cost prohibitive, but it also prolongs hospitalization. However, it is avoidable. This condition needs to be reviewed to improve patients’ outcomes in the ICUs. This project aims to decrease or eliminate the incidence of CLABSI among ICU patients through proper and mindful hand hygiene. Healthcare providers should be aware of the different care bundles that contribute to decreasing CLABSI and be able to apply them correctly. Articles were searched on different databases such as Cochrane …

Assessing The Impact Of Daily Chlorhexidine Baths In Prevention Of Central Line Associated Bloodstream Infections: An Evidence Based Project, Brooke Rea

MSN Capstone Projects

Background: The rates of central line associated bloodstream infections (CLABSI) is a major concern in the healthcare industry. It is imperative that healthcare professionals take every precaution to prevent these life-threatening infections to the already critically ill patient.

Objective: The reason for this paper is to assess the effectiveness of the use of daily chlorhexidine baths in patients with central lines in the prevention of CLABSIs.

Narrative Review: A narrative review of evidence was conducted to assess the effectiveness of daily chlorhexidine bathing in patients with central lines. Twelve studies were moved forward in the project. Each of the twelve …

Exploring The Influence Of Postnatal Depression On Neonatal Care Practices Among Mothers In Western Kenya: A Qualitative Study, Florence Achieng, Alloys K’Oloo, Hellen Barsosio, Simon Kariuki, Helen Nabwera

Obstetrics and Gynaecology, East Africa

Background: Postnatal depression (PND) is associated with adverse infant neurodevelopmental outcomes. Evidence is limited on how PND influences neonatal (<28 days old) outcomes in low- and middle-income countries, such as Kenya, which bear the global burden of neonatal morbidity and mortality.

Objectives: To explore how PND influences neonatal feeding and care practices among women in the early postnatal period in rural Western Kenya.

Design: A cross-sectional study.

Methods: Semi-structured interviews were conducted at 2-weeks postpartum among mothers of newborn infants identified <72 h old from the postnatal wards and clinics across five health facilities in Kisumu County of Western Kenya. They were all screened for features suggestive of postnatal depression using the Edinburgh Postnatal Depression Scale.

Results: Twenty-four mothers were interviewed, 13 of whom had features suggestive of PND. All mothers experienced health or socio-economic adversities in the perinatal period, including traumatic deliveries, financial constraints, and challenging relationships with partners/other family members. Feeding difficulties due to …

Implementation Of An Evidence-Based Diabetic Screening Tool In Rural Belizean Communities, Morgan Lee Taylor, Annelyse Caffrey

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Significance/Background: Type II Diabetes Mellitus (TIIDM) is a growing epidemic in Belize. The prevalence is increasing yearly, responsible for considerable health complications and deaths. Rates are much higher in Belize than in any other developing Central American country, and many rural citizens are undiagnosed and untreated. Access to healthcare is complex, and travel is often required in rural areas. Primary care visits in Belize are significantly less than in surrounding North and Central American countries. As a result, chronic illnesses such as TIIDM often go undiagnosed among children, adolescents, and adults- leaving TIIDM a leading cause of death in Belize. …

Using Physical Therapy As First Line Treatment For Sciatica Vs. Invasive Intervention, Christina Mohammed

Master of Science in Nursing Family Nurse Practitioner

Sciatica nerve pain affects a large part of the human population. Evaluation by a primary care provider and a referral to physical therapy as first line treatment, may help reduce sciatic nerve pain and result in reduced need for invasive surgical intervention.

Introduction Of Hiv Point-Of-Care Testing In Adolescent Primary Care: A Quality Improvement Project, Jennifer Quinn Belfry

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: HIV, first identified in 1981, remains a persistent public health problem affecting 1.1 million Americans today. Detection is a critical first step to ending the HIV epidemic and the CDC recommends universal HIV screening for all patients 13-64 years of age regardless of risk factors. HIV screening rates are suboptimal especially in adolescent and young adult populations who face unique barriers to screening. The aim of this project was to improve HIV screening rates in adolescent and young adult patients at a large, urban FQHC.

LOCAL PROBLEM: In the state of Rhode Island, 1 in 10 persons living with …

Implementation Of A Comprehensive Diabetic Foot Care Program In Primary Care, Peguy Sylvain

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Diabetes Mellitus is a growing health problem in America. Uncontrolled diabetes can result in vascularcomplications. One of the most common complications of diabetes is diabetic peripheral neuropathy. Early foot carescreening can help prevent Diabetic peripheral neuropathy and other complications such as skin injuries, burns, falls,infection, lower- extremity amputations, and peripheral arterial disease. Interventions that have been shown to improve theidentification of diabetes foot complications include staff education, screening and assessment, use of monofilament,tuning fork for diabetic foot assessment, patient education/ self-care, standardization, and use of electronic medical records(EMR)/electronic reminders.

METHODS: The Plan Do Study Act method of quality improvement …

Infertility: An Evaluation Of Treatment Modalities And Ethical Considerations, Elise Ferenczy

Senior Honors Theses

This thesis reviews a variety of options for treatment of infertility, along with ethical considerations for each. The basis for ethical concerns will be primarily a biblical worldview, as the goal is to support Christian couples in decisions regarding infertility treatment. The biblical worldview is outlined to provide readers with an understanding of its core principles, and the Bible is used as the primary source for ethical discussion. The most common etiologies of infertility are outlined, followed by treatment modalities grouped by category. While some modalities present very few ethical concerns, others require careful consideration in many regards. Many of …

The Utilization Of Depression Screening Tools In Patients With Diabetes Type 2, Hanna Book, Kennedy Eldridge, Margaret Harvey Phd, Aprn, Acnp-Bc, Chfn, Artangela Henry Dnp, Agacnp-Bc, Fnp-C, Laura Reed Dnp, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Diabetes and depression are highly prevalent and concerning conditions impacting millions worldwide. Evidence-based guidelines recommend regular depression screening of individuals with type II diabetes (DM2) to appropriately diagnose and treat depression and proactively enhance clinical outcomes. The gold standard for determining depression in patients with chronic disease is the diagnostic clinical interview; however, many clinicians have turned to brief, self-reported screening tools such as the PHQ-2 and the PHQ-9 whose use are recommended by evidence-based guidelines. This study aims to assess the utilization of the PHQ-2 and PHQ-9 versus no screening on DM2 patients in a primary care setting. …