Family Practice Nursing Commons^™

The Role Of An Advanced Practice Provider (App) And Its Relation To Physician Shortages And Rural Healthcare Survival: A State-By-State Analysis, Allen Anderson

Dissertations, Theses, and Projects

The extent that Advanced Practice Providers (APPs) are able to practice independently with a full scope of practice varies state-by-state. The purpose of this paper was to review how APPs could help in a number of different areas of healthcare. This analysis examines the state of rural healthcare and reviews physician shortage statistics and hospital closures by state. In the examination, it also evaluates which states have full scope, reduced scope, and restricted scope of practice laws and cross-references that with states that have experienced a hospital closure. Through case studies, this research finds that APPs can be an alternative …

Improving Infection Management Of The Institutionalized Elderly, Jovel Angela Viloria Broqueza

Doctor of Nursing Practice Projects

Abstract

As the elderly population rapidly grows in the United States, the burden of managing infection in long-term care facilities (LTCF) escalates. The use of evidence-based infection identification algorithms for early recognition and treatment of pneumonia, urinary tract infections (UTI) and skin and soft tissue infections (SSTI) was evaluated at a Midwest suburban 110-bed long-term care facility. Focus group sessions were conducted at the facility with four nurse practitioners, the medical director, eight nurses and certified nursing assistants (CNAs) prior to an educational in-service which was provided to all staff at the facility. As criteria of infection were reported, nurses …

Strong Recommendation Towards Hpv Vaccination, Danielle Bogue

Doctor of Nursing Practice Projects

Risk of future HPV related cancers remains high in individuals unvaccinated against HPV, leading to too many people dying from this preventable cancer. However, primary care providers’ strong recommendation to vaccinate and family education about HPV and vaccine efficacy have a positive impact on a family’s decision to vaccinate. The setting for this project was a Midwest suburban family healthcare practice. This process was implemented by providing the guardian with a handout, a short video on HPV, a question and answer period with the provider, and ended with the provider giving a strong recommendation towards HPV vaccination. Of the 35 …

Implementation Of High Blood Pressure Guidelines In Clinical Practice, Jessica Walker

Doctor of Nursing Practice Projects

Abstract

This quality improvement project implemented 2017 Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults. An in-service education session on the 2017 High Blood Pressure Guidelines was provided to clinical staff. In addition, the AHA/ACC pooled cohort 10-year risk calculator was installed to computer desktops or smart phones, for providers. “Seven simple tips to get an accurate blood pressure reading” (American Medical Association, 2016) was posted in exam rooms and proper measurement and documentation techniques were reviewed with clinical staff. Review of recommended non-pharmacological treatment methods with proper patient education documentation was also conducted. …

Keep The Beat With Heart Failure Education: A Quality Improvement Project, Brenda L. Peterson

Master's Projects and Capstones

Abstract

Problem: Heart failure (HF), also known as congestive heart failure (CHF), is the number one diagnosis-related group (DRG) for people 65 years of age and older in the United States. This disease group is complicated and debilitating, requiring frequent hospitalizations with high mortality rates. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has identified CHF as an area for improvement in hospitals.

Context: This was a quality improvement project for an integrated medical center in the Central Valley, California with over 19,000 HF patients. In 2018, for patients 65 years and older, HF is the third-most admitted DRG …

Implementation Of A Nurse-Led Diabetes Self-Management Education (Dsme) Program In Primary Care, Jamie Lee

Nursing and Health Professions Faculty Research and Publications

Type 2 Diabetes Mellitus (T2DM) is a serious concern, that requires close monitoring and facilitation of self-management skills and strategies, as well as development of a sense of self-efficacy, in patients with this chronic disease. The development of nurse-led Diabetes self-management education (DSME) programs, combined with a multidisciplinary approach to care and management, is a safe and effective means of helping patients with uncontrolled T2DM to cultivate positive health behaviors, prevent long-term disability and effectively control blood sugars.

A DSME program like this was developed and implemented at Mercy Midtown Family Practice, for patients with a glycosylated hemoglobin (HbA1c) of …

Anemia Management For Patients Receiving Peritoneal Dialysis, Kenisha Marajah

Doctor of Nursing Practice

The purpose of this quality improvement project was to develop an anemia management evidence-based intervention for patients receiving peritoneal dialysis (PD) and to educate staff on implementation of the anemia management protocol in a PD clinic in a southwestern county in Texas. Anemia is a common complication of chronic kidney disease (CKD) resulting from the inability of the kidneys to produce erythropoietin needed for red blood cell production. Erythropoiesis-stimulating agents such as Aranesp or Epogen may be administered to dialysis patients to stimulate erythropoiesis in the presence of kidney disease. Iron storage and iron availability remains imperative in effectively stimulating …

Establishing A Coumadin Clinic In A Rural Family Medicine Practice, Kathleen E. Zeledon

Doctor of Nursing Practice

Background. Coumadin is the most commonly prescribed oral anticoagulant worldwide and is safe and effective in the prevention and treatment of stroke and venous thromboembolism (Stoudenmire, DeRemer, & Elewa, 2014). Coumadin is dangerous when poorly managed due to high risk for bleeding and mortality. It is best managed using evidenced-based models of care such as point-of-care (POC) International Normalized Ratio (INR) testing (Garcia et al., 2008; Harrison, Shaw, & Harrison, 2015; Rossiter, Soor, Telner, Aliarzadeh, & Lake, 2013). Purpose. Establish a Coumadin Clinic in a rural family medicine practice with POC INR testing to improve anticoagulant management. Methods …

Diabetes Education And Management, Dina Balzano

Doctor of Nursing Practice

Purpose: Implementation of a diabetic self-management and education program based on the 2017 national standards of care.

Background: Empowering patients with the knowledge to manage their diabetes in conjunction with health care provider’s recommendations is essential. The American Association of Diabetes (2012) and American Association of Diabetic Educators (2017) have deemed the use of diabetic self-management education and support as the highest level of evidence based practice to prevent and effectively manage the long-term complications of diabetes (Burke, Sherr & Lipman, 2014).

Methods: The project was implemented at a family practice clinic in south San Antonio. A diabetic self-management and …

Assessing The Effectiveness Of A Quality Improvement Intervention To Decrease Missed Opportunities For Human Papillomavirus Vaccination At A Nurse Managed Health Center, Maria Medina-Calvo

Doctor of Nursing Practice

Purpose: To decrease the number of missed opportunities for human papillomavirus vaccine eligible patients seeking healthcare in a Nurse Managed Health Center. Background & Significance: Human papillomavirus genital infection has inflicted nearly 79 million Americans. Annually, about 14 million newly infected individuals are identified, with noted predominance in teens and young adults, and of this number approximately 19,200 females and 11,600 males receive a cancer diagnosis as a result of the human papillomavirus infection. The incidence of infections can be reduced with a human papillomavirus vaccine, but only about 63% of females and even fewer males initiate the human papillomavirus …

Incorporating Waist Circumference Screenings To Initiate Preventative Lifestyle Modification Education: A Feasibility Study For A Clinical Practice Change, Tracy Stahl

Doctor of Nursing Practice Scholarly Project

INCORPORATING WAIST CIRCUMFERENCE SCREENINGS TO INITIATE PREVENTATIVE LIFESTYLE MODIFICATION EDUCATION: A FEASIBILITY PILOT STUDY FOR A CLINICAL PRACTICE CHANGE

An Abstract of the Scholarly Project by

Tracy Stahl MSN, FNP-C

The purpose of this study was to evaluate provider perceptions and willingness to incorporate adult gender-specific waist circumference screenings as a clinical practice change. The project was conducted at the 4-State Advanced Practice Nurses (APN) conference in March 2018. The study consisted of a two-part study that utilized a pretest, educational PowerPoint presentation, posttest, and eight-week posttest to determine self-reported provider practices. Part one of the study analyzed the pretest …

Building Shared Values In The Community: Culture Of Health, Donnelle D. Storrs

Doctor of Nursing Practice

The zip codes where patients live are stronger determinants of health outcomes than the frequency of visits with a primary care provider. Providers have a unique opportunity to extend health care beyond the clinic walls and engage in efforts to improve the communities where their patients grow, live, work, and age. In order to impact the health of patients, a culture of health needs to be developed. The Robert Wood Johnson Foundation culture of health action framework directed the build of a foundation of health as a shared value in a neighborhood with high morbidity and mortality rates in southwest …

Implementing Pneumococcal Vaccination Recommendations For Adults Age 19 And Over In A Family Care Clinic, Truc Le

Doctor of Nursing Practice

Pneumococcal vaccines are essential to children and adults. Having pneumococcal vaccines not only prevents pneumococcal infections but can also potentially lessen the severity of the disease. There are many scholarly articles attesting the herd effect in adults who received pneumococcal vaccines. Therefore, the purpose of this quality improvement project was to raise awareness of the pneumococcal vaccine and increase the vaccination rate in a primary care clinic in Texas. The Centers for Disease Control and Prevention’s pneumococcal vaccination schedule was utilized as guide for vaccine administration. The staff and provider were educated on screening, documenting, and administering the pneumococcal vaccine …

Implementing The Hyperlipidemia Statin Use Guideline In Patients With Diabetes Mellitus, Ifeyinwa Eribenne

Doctor of Nursing Practice

Purpose. To implement an evidence-based hyperlipidemia guideline for statin therapy use with diabetic patients. Background. In the United States, cardiovascular disease (CVD) continues to be the leading cause of mortality and morbidity for women and men with diabetes. Dyslipidemia is a modifiable risk factor for CVD and one of the leading drivers behind the development of coronary artery disease. In 2014, the American Diabetes Association issued a new recommendation guideline for using statins as a primary intervention for CVD in patients aged 40–75 with diabetes. Despite advances in prevention and treatment guidelines, the American College of Cardiology and ADA have …

Quality Improvement On Depression Protocols In The Military Training Environment, Priscilla R. Colunga

Doctor of Nursing Practice

Background: Active Duty military members are highly susceptible to depression and suicide due to separation from family during training and deployments, exposure to traumatic experiences in combat, and loss of friends during combat.

Purpose and Objectives: Depression and suicide remain a high priority among military personnel. This process improvement project aimed to improve the rate of depression screening and improve the assessment, treatment, and management of soldiers with depression in a primary care setting to prevent disease progression while waiting to be seen by a behavior health specialist.

Interventions: During the 6-week time frame, all active duty military and reservists …

Implementation Of The Human Papillomavirus Vaccine Among Health Professions Students, Emeka C. Nnabuife

Doctor of Nursing Practice

The human papillomavirus (HPV) is the most widespread sexually transmitted infection in America. College-aged students are a high-risk group for HPV transmission, but their HPV vaccination rates are low. The purpose of this evidence-based project was to implement an HPV vaccination program at a health science center university student health clinic to increase vaccination rates to meet the guidelines of the American College Health Association (ACHA) and the Centers for Disease Control and Prevention (CDC). The objectives of this project were as follows: 1) to educate providers and staff on the importance of the HPV vaccine; 2) to increase HPV …

The Implementation Of Obesity Guidelines In A Rural Clinic, Teresa M. Beard

Doctor of Nursing Practice

Background Over 36% of Americans are obese. It is estimated that, by year 2030, 51% of the population will be obese. With the increased prevalence of co-morbidities associated with obesity, it is important to gain control of this disease. Method The aim of this project is to implement the 2013 American College of Cardiology, American Heart Association Task Force on Practice Guidelines, and The Obesity Society Guidelines for the Management of Overweight and Obesity in Adults in order to identify those patients who require treatment for obesity and provide them with appropriate resources. The primary interventions are to provide color-coded …

Hiv Screening In Non-Pregnant Patients Age 13 – 64 Years Old In Primary Care Through The Implementation Of The Cdc Guidelines For Hiv Screening, Ashten M. Martin

Doctor of Nursing Practice

As many as 216,000 people living with HIV are unaware they have the disease. In order to combat the inadvertent spreading of HIV, the CDC recommends screening everyone 13 – 64 years of age. The purpose of this Quality Improvement project was to implement the 2015 Sexually Transmitted Diseases Treatment Guidelines as it pertains to HIV screening within a Southeast Texas rural health clinic. The objectives were 1) educating all staff and patients regarding the CDC recommendations for HIV screening, and 2) increase the number of eligible patients who were offered and received HIV screening. A colored checklist served as …

Eye Examination:Satisfying A Quality Care Measure In Diabetes, Meera Shekar

Dissertations

Abstract

Purpose: Diabetic retinopathy (DR), a microvascular complication occurs in patients with poorly controlled diabetes mellitus (DM). A known risk of increased visual impairment associated with DM occurs in patients when the glycosylated hemoglobin level (HbA1c) increases over 7.0%. Therefore, an annual retinal assessment as a quality care measure in diabetes management is necessary. The conducted study aimed to evaluate the documentation of an annual eye exam in all patients with DM in a private family practice clinic and to investigate any possible association between HbA1c level.

Method: This quality improvement study included a retrospective medical record review in …

Nurse Practitioner Students: Providing Wellness Screenings To Underserved Older Adults, Rexanna Tatlock

Purdue Journal of Service-Learning and International Engagement

Rexanna Tatlock (BSN, RN, CCRN) received a BSN from Saint Francis College in 2003. As a registered nurse, she specialized in critical care nursing and eventually enrolled in the Adult Gerontology Nurse Practitioner master’s program in Purdue University’s School of Nursing in 2016. Upon graduation in May 2018, Rexanna has planned to focus on primary health care. The service-learning project provided primary care clinical experience, while meeting the needs of an underserved older adult population. This article will discuss the community partnership, a needs assessment, and a wellness screening offered to Fairington Apartments (FA) residents.

Women's Quality Of Life After Leaving An Abusive Relationship: The Effects Of Past And Ongoing Intimate Partner Violence, Mastery And Social Support, Diana Jaradat

Electronic Thesis and Dissertation Repository

Intimate Partner Violence (IPV) is considered a major stressor that threatens the lives of women globally. Although qualitative research suggests that IPV has substantial negative effects on women’s quality of life, few quantitative studies have examined the quality of life of women who have experienced IPV due, in part, to the lack of an appropriate, brief measure of QOL. Consequently, little is known about the contextual process by which IPV experiences affect women’s quality of life (QOL) after leaving an abusive relationship. Mastery and social support are two important resources that women may use to deal with IPV but whether …

Pain Management: A Flowsheet For Providers, Lisa Swezey

Doctoral Dissertations and Projects

Many different factors led to the trend of providers prescribing opioids for chronic pain. However, the misuse of and many deaths related to opioid prescriptions have caused the trend to reverse its direction. National organizations call for providers to stay clear of opioid medication and increase the use of nonpharmacological pain management, but also to treat pain adequately. There are still many barriers to decreasing the use of opioids and increasing the use of nonpharmacological methods. This scholarly project hoped to use an educational flowsheet to assist providers in meeting the demands from national organizations to decrease the use of …

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 …

Increasing Hcahps Scores By Scripting Of Hourly Rounding, Katherine Rivera

Doctoral Dissertations and Projects

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized national report on patient perceptions of care and is now linked to hospital reimbursement by both government and now some independent insurance companies. Healthcare systems are therefore very interested in ways to increase patient satisfaction within their facilities. This evidence-based practice pilot project was based on the Iowa Model of Evidence and used a quasi-experimental process to ascertain if adding scripting to the hourly rounding process was able to increase patient satisfaction scores on the HCAHPS. The increase in patient satisfaction, in the area of perceived responsiveness …

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, …

Gender And Experiences Of Family Homelessness, Fawziah Almalki

Electronic Thesis and Dissertation Repository

BACKGROUND: Family homelessness is a growing issue in Canada. Families have been reported as the most rapidly increasing population of emergency shelter users. The purpose of this study was to understand the experiences of family homelessness in A mid-sized Canadian city and, in particular, the role that gender plays in these experiences.

METHODS: This project was a secondary analysis situated within a critical theoretical perspective. The data for this study, consisting of 4 focus groups, 36 family member participants interviews, and 10 shelter staff members interviews, was extracted from a primary study that focused on diversion from family homelessness. Qualitative …

Pediatric Primary Care Concussion Evaluation And Management, Kaitlyn Layman

Doctoral Dissertations and Scholarly Projects

Concussions are an important and timely subject, especially within the pediatric population, as they are the most involved in extracurricular contact sports and are susceptible to concussions and their sequelae. The researcher performed a quasi-experimental pilot study in a pediatric primary care office where the researcher educated 15 providers on the HEADS UP concussion screening tool and management approach. The researcher gave providers pre- and post-intervention surveys to determine if providers’ comfort and knowledge regarding assessing and managing concussions within the pediatric primary care setting changed. Four providers participated in the study. The researcher conducted a chart review two months …

Nurses Role In Health Home Mixed Methods Study, Jacqueline S. Prokop

Nursing Theses and Dissertations

Managing individuals with chronic health conditions in the primary care setting continues to be a significant challenge in the U.S. health care system. This issue is further compounded for low-income individuals with both mental health and physical health chronic conditions. With the enactment of the Affordable Care Act (ACA), new chronic disease health home opportunities have emerged to address the existing structural and process gaps found in primary healthcare. The nurse’s role is integral to health homes as they empower nurses to play a greater role in improving patient experiences, population health, and lowering healthcare costs. Three research manuscripts presented …

Benefits Of Interprofessional Education Between Advanced Practice Nurse Practitioner And Dentistry Students, Oksana Prodan

DNP Qualifying Manuscripts

Background: Interprofessional Education (IPE) is mandated for accreditation in health professional schools. IPE between Advanced Practice Registered Nurse (APRN) and dentistry students have been developed to improve health oral systemic health outcomes and improve inter-professional practice competencies.

Method: Literature on APRN dental IPE was searched was searched via CINAHL Complete from 2007-2018, looking for scholarly journals, English language. The search was narrowed from 55 to three relevant, data-based studies.

Results: Review of literature produced one study demonstrating benefits of IPE for both APRN and dentistry students, one study only focused on benefits for APRN students, and another IPE article was …

Educational Prevention Program Of Surgical Site Infections (Ssi) At A Metropolitan Pediatric, Daniel Chavez

Master's Theses

Surgical Site Infections are a common hospital acquired disease. The prevention of Surgical Site Infection at a metropolitan pediatric hospital was lacking thorough education on how to prevent Surgical Site Infections. Literature was used to support this educational program with evidence based practices. To further reduce Surgical Site Infections education played a key role. Most importantly the distribution of education is what this educational program aimed toward supporting. In order to optimize patient outcomes through the use of our educational program literacy requirements must be me. Using this information our team constructed educational pamphlets that would help empower patients so …