Family Practice Nursing Commons^™

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Research, Evidence-Based Practice And Quality Improvement, Tonya Traylor

DNP Final Reports

Background: The United States is in the midst of an opioid epidemic. In 2012 alone there were approximately 259 million prescriptions written by primary care providers for opioids painkillers. The U.S. Center for Disease Control (CDC) now has new guidelines and recommendation due to the opioid analgesic epidemic. Education has been found to raise provider awareness and, subsequently, has decreased opioid use. Provider education helps with reinforcing the short-term use of opioids and adjunctive therapies and helps reinforce the idea of an individualized treatment plan for patients. Purpose: The purpose of this intervention is to increase provider education on opioid …

A Multi-Component Education, Skill, And Resource Evidence-Based Practice Intervention For The Alzheimer’S Caregiver, Cheryl Garmon

DNP Final Reports

Abstract

Dementia caregiving is expensive, stressful, and consumes all facets of the caregiver’s (CGs) life. The purpose of this project is to introduce the evidence-based practice (EBP) interventions most helpful in decreasing stress and burden in those who are in-home caregivers for Alzheimer’s disease and related dementias (ADRD) individuals.

The three primary intervention domains of the EBP studies that results in a positive impact are; providing education about the terminal course of the disease, introducing communication and caregiving skills, and furnishing resource and social network information.

The methodology included a convenient and voluntary population of CGs who sought service at …

Diabetes Shared Medical Appointment: An Evidence-Based Innovation Project, Mohamed Bojang

DNP Final Reports

The purpose of the evidence-based practice innovation project (EPIP) is to address uncontrolled diabetes by implementing an evidence-based shared medical appointment (SMA) intervention which based on the body of the evidence will help improve diabetes outcomes. A pilot implementation and retrospective chart review were conducted. Data was collected on outcome indicators such as blood pressure, lipid values, body mass index, A1C, and knowledge. The results of a pilot SMA implementation revealed that patients who participated in the weekly SMA saw an improvement in post-mean values compared to pre-mean values. Mean A1c dropped to 7.0% from 7.11%; systolic blood pressure improved …

Where Are We Now? Practice-Level Utilization Of Nurse Practitioners In Comparison With State-Level Regulations, Jana Zwilling, Kathryn Fiandt

Posters and Presentations: College of Nursing

Background. Full practice authority for NPs is optimal for high-quality, cost-effective healthcare. However, a complete picture of utilization after states have adopted full practice authority needs to be determined. Objective. To review the evidence regarding practice-level utilization (PLU) of Nurse Practitioners (NP) PLU in comparison to state-level regulations (SLR). Data Sources. Studies published in English and based on US populations were identified through PubMed, CINAHL, and SCOPUS (January 1, 1989 - December 31, 2018), and bibliographies of retrieved articles. Of the 419 articles identified with these limits, 19 (5%) met all inclusion and exclusion criteria. Conclusions. Four categories …

Breathe In Breathe Out...Now What? Improved Pediatric Asthma Outcomes Through Improved Inhaler Technique, Gina M. Nickels-Nelson

DNP Final Reports

Asthma is a chronic disease affecting families in the United States; especially pediatric patients aged 5-18. In Pittsfield, Massachusetts the local prevalence of asthma is 14.4% versus 12.1% statewide and 8.4% nationally. These patients miss school days thus causing parental workday loss. In 2016, 14.4 million missed school days occurred due to asthma (Alexander et al., 2016). Unexpected clinic visits, as well as emergency room visits due to asthma, can contribute to rising healthcare costs both locally and nationally. Unexpected asthma visits are a leading reason for visits to this author’s clinic.

Asthma is treated with inhaled medications through a …

Student And Faculty Perceptions: Appropriate Consequences Of Lapses In Academic Integrity In Health Sciences Education, Tianna Antill Keener, Marina Galvez Peralta, Melinda Smith, Lauren Swager, James Ingles, Sijin Wen, Mariette Barbier

Faculty & Staff Scholarship

Background: A breadth of evidence supports that academic dishonesty is prevalent among higher education students, including students in health sciences educational programs. Research suggest individuals who engage in academic dishonesty may continue to exhibit unethical behaviors in professional practice. Thus, it is imperative to appropriately address lapses in academic dishonesty among health sciences students to ensure the future safety of patients. However, students and faculty have varying perceptions of what constitutes academic dishonesty and the seriousness of breaches in academic dishonesty. The purpose of this study is to gain health sciences faculty and students’ perceptions on the appropriate consequences of …

Mitigating Prescription Opioid Risk: Prescription Drug Monitoring Programs, Brenda Vigue

Doctor of Nursing Practice (DNP) Projects

Background: Opioid-related morbidity and mortality is a serious public health issue in the United States. Prescription Drug Monitoring Program (PDMP) review prior to prescribing opioids has consistently been recommended as best practices for risk mitigation, however, access/utilization of this monitoring program remains low.

Methods: This quality improvement (QI) project for improved PDMP utilization employed a pre-post survey design in a random sample of Advanced Practice Registered Nurses in Arizona. Quantitative measures included online surveys with close-ended responses to salient items from the review of literature and best practices. A follow-up survey was requested of the participants who provided their …

Program Evaluation Of An Easy Access Clinic For Effective Contraception For U.S. Active Duty Women In Okinawa, Japan, Cynthia Kuehner

Doctor of Nursing Practice (DNP) Projects

Background: Unintended pregnancy in the United States (U.S.) is a significant health problem that takes on additional magnitude in the context of military service. Young, active duty women have higher unintended pregnancy rates compared to the general population, secondary to non-use of contraception or selection and use of the least effective methods (condoms and oral contraceptive pills). The literature validates the problem, identifies access barriers to highest-efficacy contraception options in primary care settings, and offers evidence-based, best practice opportunities to impact this public health challenge.

Purpose: The purpose of this project was to evaluate access, utilization, effectiveness, and patient satisfaction …

Promoting Sleep Health Through Identification And Management Of Obstructive Sleep Apnea, Melissa Vuolo

Doctor of Nursing Practice (DNP) Projects

Background: There is a high prevalence of obstructive sleep apnea in the United States, which left untreated can lead to increased cardiovascular risk. The current practice standard is to use a questionnaire to evaluate a patients’ sleep health, but this is not done regularly in every clinical setting. This DNP project aimed to bridge the gap in practice by implementing regular screening of obstructive sleep apnea in an urgent care center in Massachusetts.

Methods: This DNP project was conducted by having adult patients complete the Epworth Sleepiness Scale to determine the presence of a sleep health issue. The patients …

Increasing Staff Knowledge And Screening Practices For Adverse Childhood Experiences In Primary Care, Angela Mcgraw

Doctor of Nursing Practice (DNP) Projects

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened …

Utilizing Motivational Interviewing To Encourage Weight Loss In Primary Care, Wendy Sergeant

Doctor of Nursing Practice (DNP) Projects

Purpose and Background: The purpose of this project was to educate nurse practitioners (NPs) and nurses (RNs) to promote healthy changes in obese individuals using the principles of Motivational interviewing (MI). Obesity is a growing epidemic in the United States with two out of every three adults considered overweight or obese. Their health problems become costly and deadly. Ideally, RNs and NPs are the front line providers in this struggle of obesity because of their philosophy of health promotion. RNs and NPs can screen and address obesity through lifestyle counseling. Motivational interviewing, a proven and effective counseling method, is useful …