Implementation Of A Provider-Focused Multimodal Educational Initiative To Address Polypharmacy And High-Risk Medication Use In A Home And Community Medicare Advantage Setting, Jennifer Butler-Rickard, Kellie Olsen, Eileen Stuart-Shor, Craig Drew

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: Community-dwelling adults are at risk for adverse drug events such as falls, hospitalizations, cognitive decline, drug-to-drug interactions, and mortality related to high-risk medication use and polypharmacy, often defined as concurrent use of five or more different medications. Lack of provider knowledge of polypharmacy and high-risk medication use as well as suboptimal communication with primary care providers can lead to gaps in medication management in this vulnerable population.

LOCAL PROBLEM: Patients seen by the Comprehensive Annual Health Assessment Program advanced practice clinicians (APCs) at the project Medicare Advantage insurer organization often experience polypharmacy. Given the lack of provider knowledge of …

A Planetary Health Approach To Address Food Insecurities In New Mexico, Mariah Kennell

Doctor of Nursing Practice Scholarly Projects

Food insecurity remains a persistent public health concern throughout New Mexico, impacting both rural and urban populations and contributing to significant health disparities. Limited access to affordable, locally sourced fresh foods exacerbates chronic disease burden and undermines community health. The purpose of this Doctor of Nursing Practice project was to conduct a comprehensive policy analysis to identify feasible state-level strategies to improve food access through strengthening local food systems. Using the Centers for Disease Control and Prevention POLARIS policy analysis framework, a structured evaluation of existing and potential state and community-level policies was conducted. The analysis incorporated stakeholder interviews with …

Ambient Air Pollution In New Mexico: Nurse Practitioner Awareness, Mckenzie Hemmes, Grayson Kemp

Doctor of Nursing Practice Scholarly Projects

Ambient air pollution is a significant public health concern in New Mexico and contributes to respiratory disease, cardiovascular illness, and adverse pregnancy outcomes (Dominski et al., 2021; Di et al., 2022). Despite well-established evidence linking environmental exposures to health outcomes, environmental exposure screening is not routinely incorporated into clinical practice. The purpose of this Doctor of Nursing Practice (DNP) project was to improve environmental health literacy (EHL) among advanced practice registered nurses (APRNs) in New Mexico and to increase their intention to integrate ambient air pollution exposure screening and mitigation counseling into routine clinical practice. A virtual educational intervention guided …

Implementation Of A Health Care Transition Pathway For Children And Adults With Inborn Errors Of Metabolism: A Pilot Project, Brittany M. Murray

Doctor of Nursing Practice Scholarly Projects

Background: Children with medically complex diseases require highly specialized care by a highly specialized team. Those with rare disease, including inborn errors of metabolism (IEMs), are a medically complex population and face significant challenges undergoing the health care transition from a child/family-centered model to an adult/patient-centered model of care. The project site follows patients with IEMs in the Metabolism Program, but previously did not have a coordinated process and had insufficient resources for patients/families for the health care transition.

Methods: The Plan-Do-Study-Act (PDSA) method was utilized as the model for improvement. Due to the complexity of the population and time …

Diabetes Self-Management Education For Older Adults In Primary Care, Makilah Rae Furlan

Doctor of Nursing Practice Scholarly Projects

Type 2 Diabetes (T2DM) is a chronic disease that impacts 27.2 million seniors 65 and older. Evidence-based care for T2DM includes a combination of medication and disease-management behaviors. Access to education to teach patients healthy behaviors to manage their disease is limited and even less accessible to geriatric patients with aging learning needs. The scholarly project addresses this gap in patient education by implementing evidence-based diabetes self-management education for geriatric patients to increase patient knowledge and confidence in implementing self-management behaviors. The scholarly project aims to assess health behaviors in patients aged 65 and older with established type 2 diabetes …

Enhancing Postoperative Care For Vascular Patients: Pre- And Post-Test Clinical Knowledge Acquisition Of Early Mobilization Education For Interventional Healthcare Providers, Jennifer Wenger

Doctor of Nursing Practice Scholarly Projects

Peripheral vascular disease (PVD) is a chronic, systemic condition that often requires surgical intervention, presenting significant postoperative risks, including complications like thromboembolisms, pneumonia, and delayed functional recovery. Evidence-based practices (EBP), particularly early mobilization guidelines, have proven to improve recovery outcomes but remain inconsistently applied among interventional healthcare providers. The project addresses this critical issue by evaluating the impact of structured educational sessions on interventional healthcare providers’ knowledge and application of mobilization guidelines in postoperative vascular care. Using the John Hopkins Model of Evidence-Based Practice, a quasi-experimental design was adopted to assess the impact of the education. The project includes pre- …

Optimizing Advance Care Planning: Leveraging An Electronic Medical Record Prompt To Impact Advance Directive Documentation, Annette L. Meares

Doctor of Nursing Practice Scholarly Projects

Abstract

Background: Advance Directives (ADs) support patient-centered care by documenting preferences for future medical treatment. While the Centers for Medicare & Medicaid Services (CMS) incentivizes AD documentation through billing codes, national adoption remains low.

Local Problem: A rural Northern Illinois primary care practice had electronic referral capabilities for ACP; however, referrals remained low and inconsistent during Medicare Annual Wellness Visits (AWVs), limiting opportunities for AD completion.

Methods: This quality improvement project targeted Medicare AWV patients without ADs documented in the electronic medical record (EMR). During a 10-week pre-intervention period, baseline data were collected. In the subsequent 10-week intervention phase, an …

Implementation Of The Nurse-Driven Palliative Care Referral Protocol: A Quality Improvement Project, Khrystyna Lacombe

Doctor of Nursing Practice Scholarly Projects

Implementation of the Nurse-Driven Palliative Care Referral Protocol

Background and Purpose: Palliative care enhances quality of life, symptom management, and patient–family communication for individuals with serious illness. Despite strong evidence and national recommendations for early integration, referrals remain inconsistent and often occur late. At Advocate Sherman Hospital, only 17.9% of eligible oncology inpatients received palliative care consults. The absence of standardized referral criteria, reliance on provider discretion, and misconceptions equating palliative care with hospice contributed to delayed or missed consults. The purpose of this quality improvement (QI) project was to increase palliative care referrals by 20% within eight weeks through …

Increasing Breast Cancer Screening Rates Among Women Ages 40 To 74 In An Urban Safety Net Primary Care Clinic: A Quality Improvement Project, Wilder Pinnock

Doctor of Nursing Practice Scholarly Projects

Background and Problem Description: Breast cancer continues to be the most common and second most lethal form of cancer among women in the U.S. Although there have been improvements in breast cancer screening in the US, major disparities persist. The national breast cancer screening rate for the year 2021 was 75.6%; the rate for the underserved and minority population was 54%. This QI project took place at a Federally Qualified Health Center that provides medical care to medically underserved and vulnerable populations.

Purpose and Aim: This project aimed to increase breast cancer screening at the proposed site to optimize early …

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, …

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 …

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 …

Examining The Need For Change By Describing The Attitudes And Perceptions Of Team Communications Related To Patient Care And Safety Among Ambulatory Clinic Healthcare Staff, Peter Seivers

Doctor of Nursing Practice Scholarly Projects

Medical errors account up to 250,000 patient deaths annually. Research suggests medical errors are attributable to poor healthcare team communications. The Institute of Medicine posits that communication and teamwork are essential components to safe and successful health care environments. According to the Joint Commission poor communication is considered the root cause of nearly 80% of all serious medical errors. Consequently, the Department of Defense and Agency for Healthcare Research and Research created a team-based training program, known as TeamSTEPPS®, which has shown to improve team communication, performance, effectiveness, patient safety, satisfaction, and health outcomes in healthcare settings. Despite evidence supporting …

Implementing Faculty Development Modules To Increase Readiness For Addressing Social Determinants Of Health, Implicit Bias And Equity In Course Content, Claudia Ngafeeson

Doctor of Nursing Practice Scholarly Projects

Implicit bias is viewed as an unconscious and involuntary attitude that lies below the surface of consciousness but can influence behavior, and cognitive processes (Maina et al., 2018). Social determinants of health are considered to be the conditions in which people are born, grow, live, work, and age; these circumstances are usually shaped by the distribution of money, power, and resources at global, national, and local levels, which in turns determines the distribution of the value of medical care. Existing literature on implicit bias has been fragmented in different fields such as; cognitive psychology, business ethics, and higher education, but …

Implementation Of A Primary Care Toolkit To Improve Dementia Diagnosis And Management In A Rural Setting, Meredith George-Wieland

Doctor of Nursing Practice Scholarly Projects

BACKGROUND: There are six million people with dementia living in the United States and this number is expected to rise exponentially due to the aging population. In the United States, it is estimated that only two thirds of dementia cases are recorded during primary care visits and an estimated, one third of cases have been either missed or disregarded.

LOCAL PROBLEM: In a remote primary care clinic on Kodiak Island, off the southeastern coast of Alaska, there is a lack of dementia and related cognitive diagnoses in the primary care setting due to patients’ and families lack access to the …

Does Nurses Confidence Improve After Attending A Training For Teaching Home Infusion Patients?, Carol Menorah Young Dnp

Doctor of Nursing Practice Scholarly Projects

Discharge can be a difficult step for patients and their families and a challenging task for nurses. Poor instructions have a negative impact on the patient population. In addition, improper and incomplete discharge information negatively affects the posthospital recovery period and may cause the patient to return to the hospital for the same episode of care. Returning to the hospital emergency room or readmission for the same episode of care will increase the dangers to the patient’s health and recovery plan and increase the cost of individual healthcare. The patient population ranks the quality of discharge information via their responses …

Health Equity & Obesity Management: An Improvement Project In A Federally Qualified Healthcare Center In Central Harlem, Brianna Bouchez

Doctor of Nursing Practice Scholarly Projects

Description of the problem: Obesity is a growing healthcare problem worldwide with extraordinary costs to the individual's health and the healthcare system. Individuals most affected by obesity include socioeconomically disadvantaged individuals, often with limited resources to seek specialized care.

Available knowledge: Various weight-loss interventions exist but access and success rates vary. Weight loss is often modest and additional factors such as social determinants of health, health literacy, and patient motivation are all factors important to the success of an intervention.

Specific Aims: The purpose of this quality improvement project was to improve self-regulatory weight loss behaviors and increase weight loss …

Hepatitis C Screening, Confirmation, And Referral Improvement Project, Maria E. Mcmahon

Doctor of Nursing Practice Scholarly Projects

Hepatitis C is an illness caused by the blood-borne Hepatitis C virus (HCV), and usually becomes a chronic condition. Left untreated, HCV can lead to severe liver disease and liver failure. Newer treatments are effective and well tolerated, but most people with chronic HCV are not accessing treatment due to several factors that will be discussed. The primary objectives of this quality improvement project were to improve the treatment cascade, provide education to providers and patients, and facilitate screening, virus confirmation, and referral to treatment, in a Federally Qualified Health Center.

Evaluating The Impact Of A Team-Based Model Of Primary Care On Provider Burnout And Patient Experience, Kimberly A. Moreland

Doctor of Nursing Practice Scholarly Projects

Background: To assure high quality, safe, affordable, and accessible health care, organizations are embarking on quality improvement initiatives to work toward the triple aim of patient satisfaction, improving the health of populations, and reducing the cost of care.

Description of the Problem: Primary care is the backbone of the health care system, but it is a challenging environment with high rates of clinician burnout. Clinician burnout undermines the ability of organizations to meet the triple aim. Innovative new care delivery models are needed that can meet the triple aim while also mitigating burnout.

Available Knowledge: A PRISMA review of the …

Limiting Potentially Inappropriate Medications In Long-Term Care, Clare M. Ironside

Doctor of Nursing Practice Scholarly Projects

Aim: This project aimed to assess the effectiveness of the STOPP/START tool in identifying and reducing potentially inappropriate medications among multi-morbid, older, long-term care residents in a metropolitan area of a Southwestern state.

Design: In this quality improvement project, seven prescribers working within four long-term care facilities were trained to assess for potentially inappropriate medications using the STOPP/START tool. The medication lists for long-term care residents (n =45) over age 65 were collected at baseline and again at three months post-intervention and assessed for overall medication use, psychotropics, and proton pump inhibitors. The project also assessed prescribers’ comfort and …

Eastern European Orthodox Christian Immigrant Women: A Pilot Study And Needs Assessment, Kimberly A. Babich-Speck

Doctor of Nursing Practice Scholarly Projects

The healthcare perceptions of the Eastern European Orthodox Christian immigrant women (EEOCIW) to the United States (U.S.) are under-represented in the literature. Although they appear similar to Americans, their cultural and religious traditions are outside the mainstream American culture. This pilot study and health needs assessment examines the women’s healthcare perceptions of 14 EEOCIW and identifies similarities and differences with 25 U.S. born Orthodox Christian women (USOCW). Between September and November 2020, interviews were conducted with Orthodox Christian immigrant women from Eastern Europe and Orthodox Christian women born in the U.S. Questions covered the perceptions of women’s healthcare, factors influencing …

An Examination Of The Impact Of Health Literacy Assessment On Incarcerated Individuals With A Diagnosis Of Type 2 Diabetes, Josi Rotunno

Doctor of Nursing Practice Scholarly Projects

Low health literacy levels limit healthcare outcomes in a variety of diagnoses. Having a low health literacy level can significantly impact an individual’s ability to manage their condition. Among these individuals are incarcerated individuals, who are especially vulnerable to low health literacy levels. Due to regulations of the correctional facility, along with the vulnerability of the population, it is often difficult to get approval for studies and to make changes within this setting[TMD1] . The stigma of incarceration, along with the difficulty in navigating the correctional setting regulations, often create barriers to making changes that could improve the health …

Evaluating Va Nurse Acceptance Of Virtual Healthcare Technology During The Coronavirus Outbreak, Francesca Bryan-Couch

Doctor of Nursing Practice Scholarly Projects

At a regional Veterans Administration (VA) hospital, nurses performing case management were unable to perform face-to-face visits with patients due to coronavirus. Care coordination and discharge planning efforts occurred through telephonic case management to preserve personal protective equipment and reduce transmission rates through social distancing. Trust and rapport between patients and nurses were reduced without personal contact. Peplau’s theory of interpersonal relations described six nurse roles and three phases of relationship development required to create therapeutic nurse-patient relationships. Connectedness was a key concept considered to be the path to a successful meaningful therapeutic nurse-patient relationship (Hrabe, 2005).

To evaluate current …

Identification Of Variables For Hemoglobin A1c Prediction, Erica A. Richards

Doctor of Nursing Practice Scholarly Projects

An evolution in healthcare is taking place throughout our country. Healthcare providers are required to achieve an ever-growing number of regulatory and metric-driven standards. This transformation aims to improve both the quality and cost of healthcare in the United States. Diabetes mellitus (DM) is one of the most costly chronic diseases in the United States. Since DM has high mortality, high morbidity, and low quality of life rates, it is no wonder that DM is one of the focuses of the National Committee for Quality Assurance performance improvement tools known as the Healthcare Effectiveness Data and Information Set (HEDIS). In …

Effectiveness Of An Aquatic Exercise Program For Reducing Weight, Body Fat And Chronic Low Back And Joint Pain, Terilyn Darley

Doctor of Nursing Practice Scholarly Projects

According to the World Health Organization (WHO), obesity has risen at an alarming rate and has reached epidemic proportions throughout the world (WHO, 2017). In the U. S., approximately 93.3 million U.S. adults are obese with an overall prevalence of 39.8 %. Chronic pain is another public health issue in the U.S, affecting almost 100 million people and is associated with significant annual healthcare costs and lost productivity (National Center for Complementary and Integrative Health [NCCIH], 2017). Exercise is considered one of the most effective prevention strategies for reducing obesity and has been documented to decrease chronic pain. The purpose …

Psychotropic Pharmacogenomic Testing: Effects On Provider Prescribing Patterns And Phq-9 Depression Screening Scores In A Rural Michigan Family Practice, Nicole Madalinski

Doctor of Nursing Practice Scholarly Projects

The rate of depression across the United States is on the rise with over 16.2 million people experiencing a depressive episode per year (Siu & and the US Preventive Services Task Force [USPSTF], 2016). Medications to treat depression typically take weeks or months to see clinical improvement (Uphold & Graham, 2013). If the medication is not effective, a dose or medication change may occur, lengthening the time spent in a depressive state. This scholarly project retrospectively analyzed charts at a rural primary care practice that implemented GeneSight® psychotropic pharmacogenomic testing for treatment resistant depression. This project sought to understand if …

Implication Of Concussion Preventative Behavior Through Youth Education On Playground Safety, Bryan Harris

Doctor of Nursing Practice Scholarly Projects

The concern with concussions has taken our society by storm as it relates to the health consequences either: acute, chronic, and/or later in life as a result of experiencing a single or multiple concussions. Research is thriving on concussion diagnosis, management, and treatment and will continue to do so in the years to come. Preventative measures in a variety of forms is the cornerstone for dealing with concussions at this time; with evidence showing formal educational programs are effective. ThinkFirst: National Injury Prevention Foundation, provides educational programs for first through eighth grade students on prevention of brain, spinal cord, and …

Using A Kindle To Improve Parental Perceptions Of Pain In Their Children: A Dnp Scholarly Project, Andrew Gearhart

Doctor of Nursing Practice Scholarly Projects

Patient satisfaction is an important goal for health care providers, as it is associated with treatment success, and patients are more likely to adhere to medical treatments when they are satisfied. Emergency departments are among the lowest ranked healthcare settings nationwide in terms of patient satisfaction. Pediatric patients often experience pain and/or anxiety while in the hospital setting and are at an increased risk of having unpleasant experiences while receiving care. The purpose of this DNP scholarly project is to determine whether the introduction of a Kindle Fire tablet was effective in decreasing parental perceptions of pain while their child …

Primary Care Provider Attitudes Towards Adoption Of Evidence Based Practice: Indicators Of Acceptance Towards Bibliotherapy, Shannon Scott

Doctor of Nursing Practice Scholarly Projects

The rising prevalence of depression is straining the skeletal mental health systems in rural communities, resulting in a majority of patients receiving management for their depression solely by their primary care providers. However, providers need to be empowered with evidence-based resources to provide adequate care beyond pharmacotherapy exclusively. Bibliotherapy, or the prescription of books for the treatment of disease, is readily used by psychologists but less incorporated into the traditional medical model of patient care. This small pilot study provided primary care providers in a rural area complimentary copies of the self-help text Feeling Good (Burns, 2009) to incorporate into …

Implementation Of The 2012 American College Of Rheumatology Guidelines For Management Of Gout In A Sample Of Midwestern Native Americans, Myrth C. Condon

Doctor of Nursing Practice Scholarly Projects

Gout is a well understood, yet poorly treated condition that is associated with many co-morbidities including hypertension, renal and cardiac disease, metabolic syndrome, central obesity and type-2 diabetes. The American Indian population is at risk for gout due an increased incidence of type-2 diabetes, chronic kidney disease, hypertension, and alcohol abuse. The purpose of this scholarly project was to implement the 2012 American College of Rheumatology (ACR) guidelines in a sample of Tribal members within mid-western portions of the United States. This scholarly project utilized a quasi-experimental research design with pretest – posttest methods to measure uric acid levels at …