Family Practice Nursing Commons^™

Aging: The Impact Of Diet And Inflammation, Morgan Wiland-Gress

Nursing Student Class Projects (Formerly MSN)

The immune system is a complex cohesive network. It requires every cell to work efficiently at maintaining homeostasis. It also prevents and repairs damage from internal and external pathogens. Recent research has focused on the concept of inflammaging, which is defined as age-related changes that occur in the immune system leading to dysfunction. The current understanding is that inflammaging contributes to the development of chronic diseases including; Type II Diabetes, Cardiovascular disease, Cancer, autoimmune disorders, neurological disorders, Alzheimer and Parkinson’s disease. The underlying pathophysiology of inflammaging is chronic inflammation and the imbalance of pro-inflammatory and anti-inflammatory mediators. This imbalance leads …

Self-Management And Quality Of Life In Young Adults After Healthcare Transition, Jennifer Herbert

Grace Peterson Nursing Research Colloquium

The transition from pediatric to adult healthcare has become healthcare concern of increasing importance as more adolescents with chronic conditions survive to adulthood requiring continuing care. In order to understand the current status of healthcare transition (HCT), we identified the HCT services received by young adults, their existing healthcare self-management skills and how skills correlated with their quality of life. A correlational and retrospective cross-sectional online survey of English-speaking young adults in the United States ages 18-26 with at least one pediatrically diagnosed chronic condition was conducted August-October 2019. Participants completed a healthcare transition feedback survey, the TRANSITION-Q self-management skills …

Improving Care For Homeless Young Adults: A Shelter Client And Health Service Provider Perspective, Kenya Kawanee Hemingway

Grace Peterson Nursing Research Colloquium

The purpose of this study was to determine if the healthcare needs of homeless young adults from the client, shelter staff, and shelter healthcare provider’s perspectives. Data was collected via focus group with homeless unaccompanied young adults (n=4), and an online survey with shelter staff and healthcare staff (n=8) of The Night Ministry (TNM) and Ignite Promise. The focus group was recorded, transcribed, and coded for themes. Inductive analysis revealed themes focused on improving the quality of services provided. Based on the findings, recommendations include assessing the needs of homeless unaccompanied young adults from their perspective utilizing larger sample sizes, …

Trust In Primary Care Providers: Perspectives From Deaf People., Greir Ander Huck Flynn

Electronic Theses and Dissertations

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts …

Solutions To Address Frequent Hospital Attendance, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

In this editorial, practical solutions and considerations in helping the most complex and at-risk patients in our health systems are discussed. These patients, sometimes referred to as health care “super-utilizers” in the literature, tend to be frequently seen and cared for in costly hospital and emergency department settings. Innovative care models that aim to bridge system gaps, achieve better health outcomes, and improve the well-being of both patients and providers are needed and should continue to be explored.

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 …

Bridging The Gap In Primary Care Of Inflammatory Bowel Disease (Ibd) Patients, Deanna Dial

Dissertations

Abstract

Problem. Patients in rural or medically underserved areas (MUAs) with inflammatory bowel disease (IBD) have limited access to primary care preventative services, making them even less likely to obtain preventative care, placing them at even greater risk for adverse health outcomes.

Methods. A two-phase retrospective chart review utilizing a convenience sample of patients diagnosed with IBD from a privately-owned gastroenterology office to evaluate the effectiveness of increasing preventative screenings for IBD patients. The first review included 53 patients seen from January to April 2019. A preventative screening

evaluation tool (PSET) was developed based on literature recommendations, including the American …

The Effects Of High Dose Intravenous Vitamin C In Cancer Patients, Bankole Aluko

Dissertations

Problem: Currently used standard treatments (Chemotherapy, radiation) in cancer patients are generally accompanied with side effects, which may include pain, nausea, vomiting, fatigue, and chemotherapy-induced peripheral neuropathy (CIPN) during and after completion of treatments. High dose IV C may improve the anti-cancer action of chemotherapeutic agents by reducing side effects of fatigue, pain, nausea and vomiting and boosting immune cell functioning, and inhibiting angiogenesis (Mikirova, Casciari, & Hunninghake, 2019).The purpose of this quality improvement project was to explore whether high dose intravenous vitamin C (IV C) prevented major side effects that frequently occur with standard treatments in cancer patients and …

Evaluation Of A Type 2 Diabetes Mellitus Care Coordination Program, Carrie Smith

Dissertations

Abstract

Purpose: This Quality Improvement (QI) project evaluated the impact of an existing Diabetes Care Coordination (DCC) program at an urban clinic for clients with no health insurance in the Midwest. Diabetes related indicators of those enrolled in the DCC program and client reported barriers were documented over a 19 month period.

Sample: Clients included were 18 years and older, with no insurance, having the diagnosis of Type 2 diabetes mellitus, and were enrolled in the DCC program within the first six months of the program's initiation.

Methods: A retrospective chart review of 24 clients recording diabetes related outcome indicators …

Coronavirus, Carla Bonczak

Nursing Student Class Projects (Formerly MSN)

Coronavirus (COVID-19) is a novel virus that began its virulent spread in China December 2019. Since that time, it has spread worldwide and has affected individuals, business, and educational systems, as well as day to day life. COVID-19 has become a national pandemic. COVID-19 is spread through airborne droplets produced by affected individual that may or may not be symptomatic. Individuals may experience fevers, dry cough, and difficulty breathing. While most individuals with COVID-19 may be able to recover at home, several are requiring hospitalization. If patients are hospitalized, they are placed into an isolation negative air flow room for …

Evaluation Of Pharmacist- Or Nurse-Driven Long-Acting Insulin Titration Protocol In Adult Primary Care Patients With Type 2 Diabetes, Ruth Manzi, Corinn Martineau, Carmine Laporta, Mary Muca, Samantha Marrier, Donald Medd, Jennifer Aronson

Journal of Maine Medical Center

INTRODUCTION

Studies have supported protocolized insulin titration to optimize insulin therapy. We implemented a long acting insulin titration (LAIT) protocol in a primary care setting to aid patients achieve optimal control of their diabetes. The purpose of the study was to evaluate the performance of the LAIT protocol.

METHODS

This retrospective analysis included patients ≥18 years with type 2 diabetes (T2D) and a hemoglobin A1c (A1C) >8% who were managed as outpatients at clinics within our health care system. We collected demographic and clinical data before and after a patient’s enrollment in the LAIT protocol. Our primary outcome measure was …

Sepsis Screening Education, Brittany R. Horn

Doctor of Nursing Practice Scholarly Project

Sepsis is a significant burden to the healthcare field with 1.7 million Americans annually diagnosed with this condition. Earlier diagnosis and treatment are the most effective ways of reducing morbidity and mortality related to sepsis. The current sepsis screening tool in place at Stormont-Vail Hospital, in Topeka, Kansas, is the systemic inflammatory response (SIRS) criteria; however, this screening tool has proven to be less effective than other screening tools available. The screening tools proven more effective than the SIRS criteria, are the quick sequential organ failure assessment (qSOFA) and the sequential organ failure assessment (SOFA). For this project, nursing staff …

Healthcare Inequities Of The Hiv Population, Michael Silvka

Nursing Student Class Projects (Formerly MSN)

AbstractThe social attitude in the United States toward people living with HIV (PLWH,) has changed verylittle since the diagnosis became prevalent in the 1980’s. Healthcare inequities experienced by(PLWH) affect their well-being in many ways every day. The ability of society to decrease theseinequities is within our grasp. (PLWH) are depending on social determinants being addressedto allow equitable access to preventative measures, testing, and treatment of their illness. Theneed for appropriate and sustainable change to social perception of the HIV epidemic must beaddressed to ensure fair and equitable treatment is available to all persons affected by thisdisease

Wound Healing, Emily Schmitter

Nursing Student Class Projects (Formerly MSN)

The topic being presented is wound healing. Wound healing is a pathological process that occurs in three phases: inflammation, proliferation and new tissue formation, and remodeling and maturation. Several factors can affect wound healing such as nutrition status, increased age and health status. Wound healing is relevant to advanced practiced nursing because APNs participate in prevention, assessment, and treatment of wounds. The APN is responsible for teaching diabetic patients about the importance of proper nutrition. The APN must also be able to identify a hard-to-heal wound. And the APN must know how to prevent infection and induce healing in hard-to-heal …

Medical Noncompliance In A Pediatric Patient Living In A Single-Parent Household, Lucy Obianuju Norrell

Electronic Theses and Dissertations

Abstract Noncompliance is a patient’s inability to comply with the recommended treatment for their complete recovery from an ailment, while compliance is the extent to which a patient adheres to the provider’s directive, such as medication and orders given. The purpose of this study was to determine if motivational interviewing when applied to noncompliant pediatric patients from single-parent households, would improve global medical compliance in this population as compared to the standard of care at the end of three months. Thirty-two participants were recruited using the homogeneous purposeful sampling. The project employed a mixed-method approach. Fred Kleinsinger’s noncompliant behavior tool …

Barriers To Colorectal Cancer Screening In Adults: An Integrative Review, Julie Sanger

Nursing Masters Papers

Colorectal Cancer (CRC) is the third leading cause of death among American men and women. Colorectal cancer is a preventable cancer, with CRC screening recommended from the age of 50. The percentage of people who complete the recommended CRC screening is low. Individuals throughout the United States (US) are rarely offered the opportunity to discuss screening options with their provider and may never complete CRC screening due to multiple barriers. The purpose of this scholarly integrative review is to explore the reasons individuals are not completing CRC screening, including those related to different US populations, and discuss interventions that can …

A Case For Delirium Risk Prediction Models To Aid In Triaging Resources To Those Most At Risk An Integrative Literature Review, Tammy Perttula

Nursing Masters Papers

Abstract

Delirium is a complex syndrome resulting from compounding effects of acute illness, comorbidities, and the environment. It results in adverse outcomes: elevated mortality rates, length of stay, readmissions, institutionalization, long-term cognitive changes, and diminished quality of life. The rate of iatrogenic delirium is astounding, ranging from 10%-89%. There are no curative treatments; thus, primary prevention is the key. The purpose of this literature review is to identify and critique the research for the accuracy of risk stratification and feasibility in practice. Support for interventions that prevent delirium is mounting; however, interventions are resource-intensive and often not implemented. Researchers have …

Type One Diabetes Mellitus In Immigrant And Minority Pediatric Populations, Kristina Nielson

Student Works

Type 1 diabetes mellitus (T1DM) is a prevalent chronic illness affecting children and adolescents. Globally, it is estimated that at least 1 million children under the age of 19 years are affected by T1DM. Immigrants and minorities have worse diabetic outcomes than the majority population. The purpose of this article is to identify common challenges in children with T1DM who are part of immigrant or minority populations. Major health challenges for children with T1DM who are immigrants or minorities include issues regarding access to healthcare, communication, and cultural adaptation. Access of children with T1DM to high-quality healthcare and new diabetes …

Insulin Injection Re-Education For Improved Glycemic Control, Daniela Shon

Doctor of Nursing Practice Final Manuscripts

Title: Insulin Injection Re-education for Improved Glycemic Control

Background: Patients on insulin therapy often continue to show suboptimal glycemic control. Data from adult patients with T2DM have demonstrated that 56.1% had poor control, despite adherence to treatment, oral and injectable. Poor glycemic control stems from many sources, including poor self-efficacy regarding insulin dosage adjustment, inaccurate insulin dosing, expired insulin, lipohypertrophy of the injection site and technique, and equipment issues.

Purpose: This project aimed to implement and assess the efficacy of re-education in the insulin injection technique for improved glycemic control.

Methods: This project was conducted based on …

Effects Of Standardized Self-Care Behavior Education On Self-Efficacy Outcomes In Type Ii Diabetes Mellitus, Nishita Patolia Bsn, Rn, Dnp Student

Doctor of Nursing Practice Final Manuscripts

An evidence-based practice (EBP) project was implemented in a primary care setting to decrease Hemoglobin A1c (HgbA1c) levels and increase self-efficacy in Type II Diabetes Mellitus (T2DM) diagnosed individuals. According to the Centers for Disease Control (CDC), 30.3 million adults have diabetes in the United States, and one in four do not know they have it (CDC, 2017). It is a disease that can be managed and reversed with standardized self-management education. Self-management interventions can improve diabetes knowledge and encourage patient participation in caring for their health (Flode, Iversen, Aarflot, & Haltbakk, 2017).

The purpose of this evidence-based project was …

Monitoring Patient And Caregiver Adherence To Treatment In Management Of Vascular Ulcers, Angela N. Ikeri

Theses and Graduate Projects

Chronic diseases have increased the incidence of vascular ulcer development. These ulcers require long-term wound management and other interventions from different health care specialists to achieve healing and decrease further complications. Following acute hospital and clinic vascular ulcer care interventions, patients are discharged home or to other facilities in the communities with vascular ulcer care instructions. Often, these patients come back to the vascular clinic or get readmitted into the hospital with deterioration of their wounds. This project used questionnaires to determine what barriers vascular ulcer patients and their caregivers have in the management of these wounds in the community. …

Unplugging: An Evidence-Based Project To Reduce Screen Time And Improve Healthy Media Use In The Adolescent Population, Erica Persichetti

Doctor of Nursing Practice Final Manuscripts

Abstract

Background:Excessive media use is an emerging health concern amongst the pediatric population. The American Academy of Pediatrics (AAP) recommends less than 2 hours per day of recreational screen time, yet the national average is between 7 to 9 hours per day for adolescents. A media-saturated lifestyle has consequences on a child’s mental, physical, and emotional health. Despite guidelines stating media use should be assessed at annual well-visits, only 16% of providers are following this recommendation. This gap in care leaves many families with a limited understanding of the impact of media on their child's health and represents a …

Mental Health Screening For Low Income Adolescents: An Evidence-Based Project, Allison Bryden

Doctor of Nursing Practice Final Manuscripts

Abstract

TITLE: Mental Health Screening For Low-Income Adolescents

BACKGROUND: Nearly 80% of adolescents in the United States will suffer from a mental illness and not receive evaluation or services. Children from low socio-economic backgrounds have an increased risk of mental health disorders which permeate into adulthood, leading to additional negative sequel and lower quality of life. Among adolescent mental health conditions, depression and anxiety are the most common. Literature has suggested provider intuition alone has low sensitivity and specificity for detecting mental illness and that screening tools are indicated.

PURPOSE: The aim of this project is to implement standardized routine …

Bridging The Gap: Improving Hospital Discharge Through Utilization Of A Priority Care Clinic, Kristian Jamerson

Doctor of Nursing Practice Final Manuscripts

Abstract

Background: Poorly coordinated care often results in poor health outcomes. Best practices in academic literature recommend effective programs that consist of comprehensive discharge planning, complete and timely communication of information, medication reconciliation, patient and caregiver education using the teach-back method, open communication among providers, and prompt follow-up visits with an outpatient provider after discharge. Using a priority care clinic (PCC) for follow-up is one approach to decrease hospital readmissions.

Purpose: To implement an evidence-based program utilizing a PCC to facilitate post-discharge transition-in-care and reduce hospital readmissions.

Evidence-based Intervention: A PCC assists patients in their transition of care from the …

Screening For Iron-Deficiency Anemia In The Pediatric Population (Ages 1-17) In Gonaïves, Haiti, Cara Rose Fratianni

Doctor of Nursing Practice Final Manuscripts

Abstract

Purpose: The purpose of this pilot project is to screen for iron-deficiency anemia in pediatric patients (ages 1-17) in a primary school in Gonaïves, Haiti. Patients with anemia will be treated with oral supplemental iron for a period of four weeks according to WHO guidelines (WHO, 2011). All students will be treated empirically for helminths per WHO guidelines, unless treated elsewhere in the last six months (WHO, 2017). Nutritional status will also be assessed using MUAC according to WHO guidelines (2017).

Background Summary: Malnutrition contributes significantly to the problem of iron-deficiency anemia, with one in four children exhibiting stunting …

Transforming Clinical Care Through Sexual Wellness Education For Community College Students, Chelsea Ovanek

Doctor of Nursing Practice Final Manuscripts

Abstract

Title: Transforming Clinical Care Through Sexual Wellness Education for Community College Students

Statement of the Problem: Unintended pregnancy remains a serious public health challenge throughout the world (World Health Organization [WHO], 2018). College-aged students continue to be a vulnerable population for this health issue, with estimates that 1 in 5 women will give birth before age twenty and 80% of those pregnancies unintended (Guttmacher Institute, 2019). Despite the statistics, approximately 40% of college students have received formal education on unintended pregnancy, sexually transmitted infections (STIs), or effective contraception use (Diedrich, Klein, & Peipert, 2017). According to the World Health …

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 …

Care After Burn Trauma: A Burn Toolkit For Providers, Whitney Weyhing

DNP Qualifying Manuscripts

Problem: A burn injury can occur in a matter of seconds. Despite advances in medical innovations and scientific progress, accidental burns continue to represent a devastating major public health burden today. Burn traumas represent a great expense to the healthcare system, affect every age and demographic, and continue to possess significant morbidity and mortality.

Context: Due to the current knowledge deficit of basic burn treatment, this Toolkit will provide current best-practice guidelines with evidence-based wound care instruction.

Interventions: An interactive educational instruction, including a pre-test and post-test of overall comprehension, from initial assessment to management of burns. Included will be …

Quality Family Planning: Enhancing The Knowledge Of Contraception Counseling In Primary Care, Allison N. Littleford

Doctor of Nursing Practice Scholarly Project

Reducing unintended pregnancies continues to be an important health initiative in the United States. National rates have demonstrated a slow decline, yet the CDC estimates rates remain near fifty percent, with rural women facing higher unintended pregnancy rates than their urban counterparts. Research demonstrates following evidence-based practice recommendations regarding family planning improves contraceptive adherence and helps women achieve desired pregnancy spacing.

This mixed methods research design evaluates provider family planning knowledge levels prior to introduction of an educational video and PDF file, and following the educational tools. Results of the study showed a majority of providers were aware of CDC …

Preventing Childhood Obesity With Increased Education On Responsive Feeding Practices In Parents Of Newborns In A Community Health Center, Heather Burns

Doctor of Nursing Practice Scholarly Project

This project sought to increase healthcare providers’ responsive feeding education to parents of newborns at a community health center in Southeast Kansas. An educational offering was held for participating providers who provided health services throughout infancy. The offering reviewed the projects’ methodology, instruments, and intervention to increase responsive feeding education. Parents of newborns who met the inclusion criteria and who presented for an initial newborn visit with their healthcare provider were invited to participate. Parents completed surveys prior to receiving education at the initial appointment and the a follow-up survey at the infant’s two-month well child appointment to analyze parental …