Family Practice Nursing Commons^™

Outpatient Medication Error Improvement, Savannah M. Klinginsmith

Master's Projects and Capstones

Patient Safety Initiative -Improving Medication Administration (Outpatient Care)

SPECIFIC AIM: We aim to Improve the medication administration process and involve all staff within 6 months

In the microsystem consisting of 14 family practice and urgent care clinics, there is not a standard process based on evidence based practices for medication administration. With and estimated of 400-600 medications (immunizations included) being administered per day, without a standard of care protocol, the risk for medication errors is evident.

Objectives and changes anticipated based on implementation of the project is to engage staff in support for improving medication administration standard of care based …

Implementation Of Food Insecurity Screening In Clinical Setting, Florence Ngozi Soba

Doctor of Nursing Practice (DNP) Projects

This project used the Stetler model of research utilization framework to apply evidence-based findings to clinical settings screening adults with type II diabetes mellitus (T2DM) and low incomes for food insecurity. The project involved the review and critical appraisal of research studies and translation of research-based knowledge into a protocol for the Peach Tree Clinic with respect to the impact of food insecurity on diabetes outcomes in adults with T2DM and low incomes who were at risk of food insecurity. In addition, the proportion of screened at-risk patients who received nutritional counseling was calculated. The proportion of patients with T2DM …

Improving Women’S Health Services By Adding Long-Acting Reversible Contraceptive Methods Into Primary Care-Focused Student Health, Shu-Chen Jennie Cheng

Doctor of Nursing Practice (DNP) Projects

Often resulting from inconsistent contraceptive use, unintended pregnancy among young women between ages 18-24 continues to be an issue in the United States. Long-acting reversible contraceptives, including intrauterine contraceptives and the subdermal contraceptive implant, are safe, effective, long-acting, easily reversible, and non-user dependent contraceptive methods, yet currently are greatly underutilized. Most of the contraceptive methods are provided at our student health services except for the highly effective long-acting reversible contraceptive methods. As family nurse practitioners and health care providers, it is essential to integrate this service into primary care-focused college student health clinics by providing evidence-based information to clinical providers …

Overcoming Barriers To Screening For Anal Intraepithelial Neoplasia For Persons Living With Hiv, Brandon Hastings

Doctor of Nursing Practice (DNP) Projects

Screening has proven an effective strategy in the management of diseases that plague the population. This technique has proven to be most effective when screening is conducted with those who are most at risk for developing the targeted illness and when the frequency of screening follows set guidelines. Currently there are no nationally recognized screening guidelines for anal intraepithelial neoplasia (AIN). Screening for AIN stands to reduce overall incidence of anal squamous cell carcinoma through destruction of the dysplastic cells before they become cancerous. The goals of this project were to identify the patient population that stands to benefit the …

Family Nurse Practitioner Mentoring Relationships' Impact On Organizational Commitment, Patricia Bartley-Daniele

UNLV Theses, Dissertations, Professional Papers, and Capstones

Family nurse practitioners (FNPs) are vital primary care providers who are responding to increased primary health care needs in the United States. Organizational commitment is reflective of workplace relationships that foster professional development, innovation, and outcome achievement. An organizationally committed FNP workforce is essential to achieving primary health care goals.

Mentorship has been proposed as a strategy to foster FNP organizational commitment. Mentoring has been characterized as a teaching-learning relationship. The mentor can serve as a guide to foster graduate FNP practitioner transition into primary care practice. Types of mentoring relationships occur in formal workplace settings or develop as informal …

Transitioning Traditional Acute-Episodic Primary Care Visits To Group Visits: An Evidence-Based Approach To Diabetes Care, Bridget Michelle Smith

Doctoral Projects

Diabetes is a national problem that has extended epidemic magnitudes. Its management difficulty impends to overwhelm acute-episodic healthcare systems and challenges the resources of current and future individual primary care providers. According to the Centers for Disease Control and Prevention (CDC) (2012), there are 25.8 million people in the United States or 8.3% of the population who have diabetes. Mississippi ranks second in the nation in the prevalence of diabetes and has the highest percentage of overweight and obese adults in the nation (CDC, 2012). In an effort to bridge the gap with delivery of quality care to patients with …

The Effect Of Shared Medical Appointments And Education On Hemoglobin A1c Levels, Gina L. Moore

Evidence-Based Practice Project Reports

Type II diabetes affects millions of people worldwide. Approximately 25.8 million or 8.3 percent of the United States (U.S.) population has type II diabetes. The number of adults in the United States developing diabetes has been projected to double by the year 2030 (World Health Organization, 2013). Diabetes is the leading cause of kidney failure and blindness, as well as the major cause of heart disease and stroke which is the 7th leading cause of death in the U.S. The purpose of this evidence-based project was to determine the effects of education during shared medical appointments with type II diabetic …

Microbial Exposure And Asthma: Applying Strachan’S Hygiene Hypothesis To Nursing Practice, Elisabeth M. Campbell

Senior Honors Theses

The incidence of asthma has risen significantly in recent decades. Asthma is a complex disease process affected by multiple factors including environmental exposure, genetics, epigenetics, and lifestyle. In 1989, the hygiene hypothesis was proposed based on Strachan’s findings suggesting increased exposure to microbes may have protective benefits against allergic rhinitis and eczema. Since that time, research in this arena has exploded as investigators seek to establish a causal link between increased microbial exposure and decreased incidence of allergic disease. The aim of this literature review is to synthesize the current research regarding Strachan’s hygiene hypothesis and identify the nursing implications …

Motivational Interviewing Education For San Mateo County’S Adolescent Healthcare Providers: Focus On Healthy Diet And Physical Activity, Emilie J. Gruhl

Doctor of Nursing Practice (DNP) Projects

Motivational interviewing has been endorsed by San Mateo County as an evidence-based effective form of behavior change counseling. Eighty percent of pediatric healthcare providers in San Mateo County have been trained in motivational interviewing, however 70% of the providers use it less than 50% of the time. The goal of this project was to reeducate the adolescent providers of San Mateo County in motivational interviewing with an emphasis on individualized training and feedback, directed toward healthy diet and exercise. Results of the quality improvement project showed an average 2.5-point increase in provider confidence on a zero to ten-point scale, and …

Primary Care At Home: Nurse Practitioners' Perceptions And Practices, Tonya Bragg-Underwood

Doctor of Nursing Practice Technical Reports

Background: Primary care at home is not a new idea, but rather a reinvention of an old and almost forgotten practice. Today, only 1% of primary care visits are provided in a home setting; despite the increasing aging homebound population in the United States. Current primary care at home research relates improved patient outcomes with primary care at home visits. Primary care at home is reemerging in the United States, but currently is not generating many positive reviews. There is a gap in the current primary care at home literature regarding nurse practitioner home visit practices and perceptions. Methods: A …

The Effect Of A Group Lifestyle Coaching Model On Hba1c And Psychosocial Constructs In Low-Income Patients With Type 2 Diabetes, Lillian Tryon, D.N.P.

Faculty Works

The epidemic of diabetes and its complications is concerning, and new approaches need to be explored for fostering better patient outcomes in a cost effective way. This exploratory study examined the effectiveness of a group coaching model on glycemic control, diabetes knowledge, diabetes empowerment, and diabetes self-management compared to usual care or participation in a 90-minute diabetes education class. A convenience sample of 34 patients with type 2 diabetes mellitus was recruited at a clinic providing services to the uninsured. Participants self-selected into the coaching group (n= 12), class group (n = 10), or control group ( …

Promoting Behavior Changes In Patients With Type 2 Diabetes Through Shared Medical Appointments, Shonda Lanette Williams

Doctoral Projects

Diabetes Mellitus (DM) is a chronic disease that affects many individuals in the United States. It was reported that a total of $245 billion is spent annually on both direct and indirect health care costs associated with the treatment of diabetes and diabetic related complications. Diabetes related complications can be prevented or delayed if proper education is done and individuals are willing to practice positive behavior changes and self-manage their disease. The purpose of this doctoral capstone project was to promote behavior changes in patients with diabetes through diabetes self-management education (DSME) in shared medical appointments (SMAs).

This project was …

An Evaluation Of The Effectiveness Of Providing Foot Care Education In A Rural Clinic Setting, Gloria Green-Morris

Doctoral Projects

Diabetes is one of the most frequently diagnosed metabolic disorders and is currently at pandemic magnitude. Approximately 1.4 million adults are diagnosed with diabetes each year. According to the American Diabetes Association (2011), the numbers of diagnoses will more than double by 2030. Because of the high prevalence of diabetes, the perceptions of risk factors and healthy behaviors are important. A good understanding of written and verbal healthcare instructions, healthcare accessibility, and socio-economic status have a direct effect on patient health outcomes and the overall health of the population (Jovic-Vranes, Bjegovic-Marinkovic & Marinkovic, 2009).

Diabetic foot complications are common concerns …

The Prevalence Of Smoking In Nursing Students, Jennifer Trotter

Undergraduate Honors Theses

Tobacco use is one of the most preventable sources of death and disease, and yet remains a worldwide problem. With the rising costs of healthcare, the focus of efforts to control them has honed in on lifestyle behaviors that contribute to the escalating costs. Within the scope of this scrutiny, the prevention or cessation of smoking and tobacco usage has become a global priority and a major focal point of worldwide anti-tobacco initiatives. The World Health Organization (WHO) has identified cessation interventions by health care professionals as a crucial factor in successful patient smoking cessation, and studies have shown that …

Long-Acting Reversible Contraceptive Methods, Same-Day Initiation And Early Removal, Sandra Mary Loehner

Doctoral Projects

Objective: The study was conducted to identify the early removal rate of Long-Acting Reversible Contraceptive (LARC) methods and factors associated with early removal.

Study Design: A non-experimental descriptive design based upon retrospective chart review of electronic medical records (EMR) was used. There was a total of 96 subjects, ages 15-47 years who had a LARC method inserted within a 12-month time period and subsequent removal within 6-months of insertion date. Subjects were grouped according to same-day insertion versus non-same-day insertion.

Results: Seventy percent of study subjects with early removal had their LARC method inserted under a same-day protocol. Most subjects …

Grief Pathways After Perinatal Loss On The Metaphorical Journey Of Loss, Jennifer Marie Jonely

Boise State University Theses and Dissertations

A study using qualitative descriptive methodology was done to learn of the decision pathways that mothers experiencing six types of perinatal loss recall making during their experiences of loss. Five participants describe their experience as they recall decisions within their journeys of miscarriage, stillbirth, fetal malformation; one carrying to term by choice (perinatal palliative care), the other terminating, a neonatal death and a SIDS death. Effort was made to understand specific available choices these mothers remember making along with their recollected experience of what was helpful and what was not helpful as they were navigating those choices. Exploring the experiences …

Pilot Study: Avoiding Readmissions Of Heart Failure Patients Across Transitions Of Care, Analiza Baldonado

Doctoral Projects

Background: A major problem facing the U.S. healthcare system is avoidable hospital readmissions. Patients with Heart Failure (HF) face variety of barriers to health care and are at higher risk for readmissions. To address this problem, evidence-based interventions focused on safe transition from hospital to home are needed.

Methods: A quality improvement pilot project was implemented to evaluate the feasibility of evidence based interventions in preventing avoidable readmissions. The project setting was in a 900 bed health care system. The descriptive statistical methods were means and frequencies. The Transition Coordinator (TC) enrolled a convenience sample of 30 participants. The evidence …

The Baby Friendly Hospital Initiative, Kathryn E. Brackett

Senior Honors Theses

Abstract

The Baby-Friendly Hospital Initiative (BFHI) is a worldwide movement started by the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) that is aimed at providing hospitals with a certification that guarantees the best possible patient-centered care for mothers and infants. It focuses on breastfeeding as optimal infant nutrition, and implements strategies to encourage and support mothers to breastfeed their infants exclusively for six months after birth. The Ten Steps to Successful Breastfeeding are a set of 10 simple, easy to understand guidelines developed by WHO and UNICEF for implementing this initiative in the hospital setting and …

Creation Of Care Coordination Team, Linda Peterson

Theses and Graduate Projects

Healthcare in the United States is fragmented and costly. Care coordination positively impacts healthcare cost and quality in healthcare systems. Case managers, social workers, and community health workers create health care teams in a health care home model. A team approach, formed by relationships built from collaboration, communication, and application of Complexity Theory, produces these outcomes. Relational coordination based on shared goals, shared knowledge, and mutual respect creates the framework from which to establish a team. Watson's Caring Science theory provides the conceptual framework to support the connectedness that occurs within a team approach. Creating a collaborative team of case …

Diabetic Assessment In A Wound Care Clinic, Laura Dooley

Theses and Graduate Projects

The number of people with diabetes in the United States is continuing to grow at an alarming rate. Over 23 million people in the United States are affected with the disease and it is estimated that the number of people diagnosed with diabetes in the United States is increasing by 1 million people annually. It is essential that nurses working in all capacities help with the prevention and management of this disease. lssues surrounding adequate patient self-management of the disease are identified as smoking, glycemic control, diabetes education, footcare, and financial concerns. An algorithm for diabetes assessment was developed to …

Pediatric Obesity: Taking Advantage Of Well-Child Visits For Early Identification, James E. Gelement

DNP Projects

Background: Pediatric obesity has reached epidemic levels in the United States and the burden of early identification and prevention lies with Primary Care Providers. With this burden comes the responsibility of increased documentation in order for patients to obtain the appropriate counseling, treatment, and referrals.

Objective: The objective of this study is to identify missed opportunities to identify pediatric patients that meet the criteria for overweight or obesity during well-child visits within a primary care practice.

Method: A retrospective chart review of 100 randomly selected patients born between 9/1/2001 and 9/1/2010 that have received a well-child visit between 1/1/2010 and …

Assessing Provider Adherence To An Emergency Contraception Guideline In Reproductive Age Women, Amber E. Davis

DNP Projects

Purpose: To determine current provider adherence to the 2010 ACOG Emergency Contraception (EC) guidelines, specifically by assessing provider EC counseling with patients at well-woman annual exam visits or during contraceptive counseling visits. A second aim of this study is to identify provider facilitators and barriers of EC discussion with patients.

Methods: Using a retrospective design, 90 medical records of patients presenting to a university clinic within the previous year were reviewed for the discussion of EC during annual exams or contraceptive counseling. Forty-five medical records were reviewed prior to implementation of the Ambulatory Electronic Health Record (AEHR) and forty-five medical …

Primary Stroke Prevention: 3-Hydroxy-3-Methyl-Glutaryl-Coenzyme A (Hmg-Coa) Reductase Inhibitor (Statin) Use In The Diabetic Patient, Amy L. Hatcher

DNP Projects

Purpose: The primary objective for this retrospective chart review was to evaluate provider adherence to the 2011 AHA/ASA Primary Stroke Prevention guideline of prescribing a statin to all diabetic patients for primary prevention of stroke, regardless of dyslipidemia. A second aim of this study is to identify provider facilitators and barriers to prescribing a statin therapy for primary prevention.

Methods: Using a retrospective study design, a random sample of 100 medical records of diabetic patients presenting to a university women’s health clinic within the previous year were reviewed for statin use and rationale.

Results: Of the 100 diabetic patients sampled, …

Sleep Disturbance And Outcomes In Patients With Heart Failure And Their Family Caregivers, Sami Al-Rawashdeh

Theses and Dissertations--Nursing

Sleep disturbance is common in patients with heart failure (HF) and the family caregivers. Sleep disturbance is known as a predictor of poor quality of life (QoL) in individual level. The manner in which patients’ and caregivers’ sleep disturbances influence each other’s QoL has not been determined. The purpose of this dissertation was to investigate the associations of sleep disturbance and outcomes in patients with HF and their primary family caregivers. The specific aims were to: 1) examine whether sleep disturbance of patients and their family caregivers predict their own and their partners’ QoL; 2) examine the mediator effects of …

The Benefits Of Breastfeeding, Avery Kordus

Senior Honors Theses

Breastfeeding research is plentiful, and the majority of the literature shows that breast milk is the superior form of infant nutrition except in the rare circumstances of infant metabolic disorders, maternal drug use, or positive HIV status. In comparison to formula, breast milk provides improved cognition, development, behavior, bonding, nutrition, digestion, immunity, and long-term health with fewer diseases and conditions in infants. Mothers are benefited by breastfeeding through bonding, faster weight loss, and reduction in certain cancers and conditions. Breast milk contains the proper amount of carbohydrates, fats, proteins, vitamins, and minerals, and is also specialized for each infant and …

Final Dnp Capstone Report: Improving Adolescent Hpv Vaccination Rates, Jessica L. Murray

DNP Projects

Background: Human papillomavirus (HPV) vaccines have been shown to be effective against HPV types that are linked to cervical, vaginal, vulvar, penile, anal, and oropharyngeal cancers. Despite Advisory Committee on Immunization Practices (ACIP) recommendations that all 11-12 year old males and females in the U.S. should be vaccinated with the three-dose HPV vaccine series, vaccination rates remain low. In 2012, only 34.9% of adolescent females and 6.8% of adolescent males completed the series. Efforts to increase vaccination rates are needed, and healthcare providers have been shown to be an important part of the solution.

Purpose: This investigation was conducted to …

Assessing Blood Pressure Control In Primary Care, Ashley W. Guiliani

DNP Projects

Purpose: To evaluate provider adherence to JNC 7 by assessing documentation of blood pressure control and interventions in the absence of control in order to assist providers in reaching Healthy People 2020 goal of blood pressure control.

Methods: A retrospective chart review was conducted for patients with essential hypertension. Data collected included blood pressure, use of a home blood pressure log, documentation of blood pressure medication compliance, and provider interventions in the absence of blood pressure control across three visits. A provider survey regarding provider barriers to blood pressure control was also completed.

Results: All surveyed providers were aware and …

Delivery Of Evidence-Based Tobacco Use Interventions In Primary Care, Amber Silberman

DNP Projects

This capstone report presents three manuscripts which focus on tobacco use interventions in the primary care setting. The first manuscript presents a critical analysis of the Public Health Service guideline on Treating Tobacco Use and Dependence. The second manuscript presents a literature review pertaining to interventions that increase primary care provider compliance with guideline recommendations. The literature obtained from these first two manuscripts led to a descriptive study, which examined the documentation and implementation of specific guideline recommendations in a primary care clinic. The third and final manuscript details this study, and presents some practical implications for improving documentation …

Novel Oral Anticoagulants: Bedrest And Bleeding In Patients Undergoing Atrial Fibrillation Catheter Ablation, Lynn Mcwhirter

UNF Graduate Theses and Dissertations

Atrial fibrillation (AF), the most common cardiac arrhythmia in persons over age 65, is associated with an increased stroke risk necessitating the need for long-term oral anticoagulation for risk reduction. With the introduction of direct thrombin and factor Xa inhibitors in the US since 2010, these novel oral anticoagulants (NOACs) are increasingly being prescribed, replacing the use of warfarin, a vitamin K antagonist. AF catheter ablation (CA), an elective procedure requiring femoral vascular access is a treatment for drug refractory and persistent AF. Bedrest, limb immobilization, and limited head of bed elevation are nursing measures utilized following femoral venous, and …

Predicting Post-Deployment Family Adaptation In U.S. Navy Families, Micah A. Scott, Esther H. Condon, Arlene J. Montgomery, Spencer R. Baker

Ellmer School of Nursing Faculty Publications

Background: Although military families worldwide face changes that include adapting to peace and wartime deployments, few studies have explored how military families adapt to the post-deployment return of a service member.

Objectives: To identify variables that predicted post-deployment adaptation of U.S. Navy families.

Methods: A mixed method study guided by the Roy Adaptation Model included a convenience sample of 142 spouses of service members recently returned from deployment. The degree to which length of deployment, prior deployments, and years married, number of children, participation in religious and family support groups, communication, race, and interdependence predicted post-deployment family adaptation was tested. …