Family Practice Nursing Commons^™

Recruiting And Retaining Np Preceptors, Angelica Renteria

DNP Qualifying Manuscripts

It is estimated that by 2020, the shortage of primary care providers will reach over 20,000. This has led to a surge of nurse practitioner (NP) programs across the nation. Recruiting and retaining preceptors is of paramount importance. Barriers and incentives to precepting must be identified in order to maximize teaching capacity. More effective ways of training NP students (NPs) need to be explored to capitalize on the time preceptors invest with students. The adoption of the OMP teaching model may facilitate training for the preceptor and improve the learning of NPs due to its simplicity and efficiency.

Wound Care Education For Primary Care Providers At A Regional Medical Center, Zaira Torres

Doctor of Nursing Practice (DNP) Projects

Problem. Due to the aging population and the high prevalence of chronic diseases such as diabetes and cardiovascular disease, in the US, millions of people suffer from chronic wounds secondary to these chronic conditions. Wound care treatment is very expensive, costing the US health care system approximately $10 billion annually. San Mateo Medical Center treats many patients with wounds. However, the treatment is suboptimal as most primary care providers (PCPs) are not trained to perform wound care according to best practice. This creates several problems such as a large number of referrals to the Vascular Clinic, visits to the emergency …

Initiating Prep In Primary Care: Addressing The Adolescent And Young Adult High Risk Populations, Igor G. Mocorro

Doctor of Nursing Practice (DNP) Projects

Problem: Adolescents and young adults (AYA) ages 13 to 24 comprise a quarter of the new HIV diagnoses in the United States. Lack of access to HIV-preventive therapies such as pre-exposure prophylaxis (PrEP) reduces opportunities to prevent HIV infection in this population. Initiating PrEP in AYA significantly reduces the negative health outcomes of HIV, but it is evident that many clinicians are still reluctant to initiate PrEP in AYA patients based on perceived threats and barriers.

Context: Primary care clinics, including school-based clinics, have an opportunity to offer HIV prevention services including PrEP. This project, the Adolescent and Young Adult …

Unaddressed Challenges For The “Most Honest And Ethical Profession:” A Pilot Study Of Web-Based Learning Strategies To Prevent Moral Distress, Kelly Straight

Doctor of Nursing Practice (DNP) Projects

Background: Nurses and nurse practitioners (NPs) face greater responsibility to address the ethical challenges that present during the course of patient care, due to advances in medical technology and pharmaceutical innovation, and because of widening disparities within the U.S. healthcare system. These ethical questions, which arise during the course of routine patient care, are increasing in both number and complexity in nearly every patient care setting. Even with codified ethical standards, unresolved and/or ongoing ethical questions and dilemmas pose further issues such as the development of moral distress. This pilot project was designed to help NPs and other healthcare workers …

Exploring The Relationship Between Dietary Self-Monitoring With A Mobile App And Weight Change, Jason Payne

Electronic Theses and Dissertations

Background: Approximately 70% of the adult population in the United States has overweight or obesity and increased risk for developing chronic diseases. Dietary self-monitoring adherence using a paper diary is associated with weight loss; however, few studies have examined this association with dietary self-monitoring apps. Objectives: 1) explore if an association exists between app-based dietary self-monitoring and weight change among adults with overweight or obesity and 2) explore the relationships between the frequency, consistency, and completeness of self-monitoring and weight change. Methods: Participants self-monitored dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned …

Dnp Final Report: Diabetic Foot Care In Hispanic Females With Type Ii Diabetes: An Evidence-Based Quality Improvement Initiative, Barbara Chapman

DNP Final Reports

Diabetes affects 30.5 million people in the United States at an annual cost of approximately 245 billion dollars. 176 billion dollars are spent on debilitating often life threatening complications affecting the heart, kidney, eye, and nervous system. Over 69 billion dollars are spent on reduced workforce productivity. Approximately 9.9% of the United States population has diabetes, the diabetic population in Texas is 11.4% and in Collin County population is 10.2%. Hispanic populations are at a higher risk of developing diabetes at approximately 12.2% nationally.

Peripheral neuropathy commonly occurs in the lower extremities of diabetic patients increasing risks of foot complications …

The Role Of Allergy Testing In Eczematic Patients: A Benchmark Study, Ashley E. Cox

MSN Capstone Projects

Eczema or atopic dermatitis (AD) is the first visible sign that indicates a much bigger and more complex problem within the body. The first presentation of symptoms is typically in individuals less than six months of age. Concerned parents bring their child to the pediatrician where a course of topical corticosteroids is prescribed, according to current AD treatment guidelines (Weston, & Howe, 2019). Long term use of corticosteroids has proven to be detrimental to the patient’s health, especially pediatric patients, in many ways such as gynecomastia, hypertrichosis, staphylococcal infections, skin atrophy, and worsening of skin diseases, just to name a …

Identification And Management Of Adolescent Alcohol Use: Screening And Motivational Interviewing, Kelsie L. Berger

Evidence-Based Practice Project Reports

Adolescent alcohol consumption is a serious health problem in the United States. Alcohol is the most widely used substance, and it continues to be the drug of choice for adolescents (CDC, 2018). Over 7 million adolescents and approximately 30 percent of high school students in the U.S. that admit to drinking more than a few sips of alcohol in the past 30 days (NIAAA, n.d.). Underage alcohol use can lead to many complications such as social, school, and legal problems, and when initiated early in life is associated with the development of alcohol use disorder (NIAAA, n.d.). The purpose of …

Efficacy Of A Mobile Application In A Chronic Kidney Disease Population, Jennifer R. Zamora

Evidence-Based Practice Project Reports

Chronic kidney disease (CKD) is associated with high healthcare costs, poor health outcomes and low quality of life (Donald et al., 2018). The US CKD prevalence is 15%, costing Medicare $79 billion in 2016 (United States Renal Data System, 2018). Self-management could reduce CKD burden (Jeddi, Nabovati, and Amirazodi, 2017). Mobile technology offers a low-cost, ease-of-access platform for chronic disease self-management (Whitehead & Seaton, 2016), potentially slowing disease progression and improving health outcomes (Jeddi, 2017). The purpose of this project was to utilize a CKD-specific mobile application, CARELogiQ, to facilitate symptom management; increasing patient satisfaction and decreasing hospitalizations and ER …

An Investigation Of Treatments For The Prevention Of Metabolic Complications For Women Suffering From Polycystic Ovarian Syndrome: Diet, Exercise, Weight Reduction And Herbal Remedies, Brenda Martinez-Puente

Nursing | Senior Theses

The purpose of this research study is to compare the views of traditional versus alternative treatments available to women with Polycystic Ovarian Syndrome (PCOS) suffering from metabolic complications. Alternative treatments include diet, exercise, herbal remedies, or any combination of the three. Pharmacological interventions for the conditions associated with PCOS such as metformin, used to control glucose levels, and clomiphene, used to treat infertility. Through the literature review, articles show herbs and plant products to have similar mechanisms of actions as the pharmacological interventions, but with less side effects. For example, cinnamon was shown to increase insulin sensitivity and pomegranate juice …

What's All The Buzzy About? Using Cryotherapy And Vibration For Pain During Vaccinations In Children, Marta L. Byma

Evidence-Based Practice Project Reports

Vaccinations are the most common painful needle procedure, with an estimated 12 billion injections given per year (CDC, 2019). The usual method for administration of vaccinations is through needle puncture, which is often painful. Children often report receiving a shot as one of the most feared and painful experiences (McMurtry et al., 2015). The purpose of this evidence-based practice (EBP) project was to improve patient experiences by decreasing the pain that is associated with vaccinations through the use of a nonpharmacological method for comfort via the Buzzy® device. After thorough analysis and synthesis of the literature, the Buzzy® device that …

Supporting Positive Lifestyle Changes Among Patients With Diabetes Mellitus Type 2, Alison Tynan

Nursing | Senior Theses

The following thesis is a compilation of literature reviewed to formulate background research for a pilot study. The literature reviewed pertains to the potential benefit of added case management for patients with diabetes mellitus type 2. A proposed pilot study, based off of this research, aims to identify topics, tools, facts, and changes that can be made to case management to improve not just the biological aspects, like HbA1c levels, but the mental and emotional as well to allow for whole person care.

The primary question being asked is “what types of support do people with diabetes mellitus type 2 …

An Examination Of The Night Burn Clinic Transition To Nurse Practitioner Coverage, Kevin J. Maxwell Dnp, Fnp-Bc

Dissertations

Background/Significance: Burns are dynamic, evolving wounds requiring prompt attention and treatment (Morgan et al., 2018). Many studies have been conducted comparing physician outcomes to those of APNs showing no difference (McCleery, Christensen, Peterson, Humphrey, & Helfand, 2011; Naylor & Kurtzman, 2010; Pioro et al., 2001; Roche, Gardner, & Jack, 2017; Spetz, Skillman, & Andrilla, 2017). Time delays which allow for progression of the injury have a negative impact on patient outcomes. Any pathway allowing for quicker review of the burn by a burn specialist should be welcomed (Kelly et al., 2013). APNs can augment physician efforts and expand access to …

Provider-Led Intervention For Overweight Or Obese African American Women Ages 18-65 With A Bmi 25 Kg/ M₂, Tonya A. Harvey

Evidence-Based Practice Project Reports

Overweight and obese African American women tend to suffer most from the impacts of diseases, health disparities, disabilities, and decreased qualities of life (Sutton et al., 2016). Most weight loss programs are not culturally specific, despite the benefits of dietary changes and increased physical activity for all groups. The purpose of this EBP project was to implement a provider-led program including lifestyle, dietary, and activity components to decrease weight, BMI, waist circumference and blood pressure in African American women. The Iowa Model of Evidence-Based Practice to promote quality care was used to guide the EBP project, aimed to address obesity …

The Implementation Of Diabetic Foot Care Into Primary Care, Shelby D. Strong

Evidence-Based Practice Project Reports

Diabetes mellitus (DM) is one of the most common metabolic diseases worldwide. It can lead to complications in many parts of the body and can increase overall risk of dying prematurely (World Health Organization (WHO), 2016). Diabetic peripheral neuropathy (DPN) in the feet is one of the most frequent complications of DM (Wang et al., 2017). Other lower extremity complications which can occur as a result of diabetic foot complication (DFC) includes peripheral artery disease (PAD), infection, ulcer and amputation. One of the obstacles for preventing (DFC) is the lack of examinations of the feet in clinical practice (Feitosa et …

A Protocol To Increase Referral Rates To Diabetic Education, David M. Rokser

Evidence-Based Practice Project Reports

In 2015, approximately 30.3 million Americans, including 10.5% of the population of Minnesota, had been diagnosed with diabetes mellitus (American Diabetes Association, 2019). Increased risk of diabetic complications including neuropathy, retinopathy, nephropathy, cardiovascular disease, and chronic wounds has been associated with an elevated hemoglobin A1C (HgA1C). Formal diabetic education has been shown to be a cost-effective intervention to reduce HgA1C. The Office of Disease Prevention and Health Promotion published an objective within HealthyPeople 2020 that seeks to increase the percentage of diabetics receiving formal diabetic education in the United States from 46.9% of adults to 58.4%. The purpose of this …

Effectiveness Of A Multi-Component Intervention Program For Treating Childhood Obesity, Suzy Free

Evidence-Based Practice Project Reports

Childhood obesity is one of the most chronic childhood illness worldwide (Centers for Disease Control and Prevention [CDC], 2019; World Health Organization [WHO], 2019). The prevalence of childhood obesity has been described as one of the most common chronic childhood conditions (CDC). The purpose of this evidence-based practice (EBP) project was to reduce the BMI scores of obese children using a multi-component intervention program that incorporates healthy eating, physical activity, and family involvement. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model was used to facilitate the implementation of this EBP project. The synthesis of the appraised literature established that utilizing …

Evaluating The Clinical Impact Of Providing Home Blood Pressure Monitors To Patients With Elevated Or High Blood Pressure, Theresa La Guardia Asmus

Doctoral Projects

Many clinicians continue to diagnose hypertension based on office-based readings, despite the 2015 United States Preventive Services Task Force recommendation for the use of home or ambulatory blood pressure monitoring to confirm the diagnosis of hypertension prior to initiating treatment. Without obtaining blood pressure readings outside of the clinic environment, it is impossible to correctly diagnose hypertension, particularly regarding masked hypertension and white coat hypertension.

Stanford Health Care implemented a quality improvement project that provided patients with a home blood pressure device to monitor out of clinic blood pressure readings. The purpose of the project was to improve clinical care …

Nurse Practitioners’ Perceptions Of Telehealth Behaviors, Michelle Austin

Doctoral Projects

Problem: NP’s must be proficient in the behaviors that are required for a successful patient encounter to provide the full benefit of nurse practitioner (NP) telehealth. Consequently, it is imperative for NPs to understand telehealth etiquette behaviors which include the technical and non-technical skills that are necessary for an effective NP-patient patient telehealth encounter (Haney, Kott & Fowler, 2015). Telehealth has been incorporated into healthcare delivery and its use is expanding. In the United States, it is predicted to be used by seven million patients in 2020 (US Department of Health and Human Services, 2018). Appropriate access to health care …

Point-Of-Care Reminders To Prompt Provider Adherence With Diabetes Care Guidelines For Adults, Eric E. Spohn

Evidence-Based Practice Project Reports

Diabetes is a complex, chronic illness, and a leading cause of morbidity and mortality (ODPHP, 2019). Gaps in diabetes care exist between clinical guidelines and interventions provided in the clinical setting (ADA, 2015; Chauhan et al., 2017; Renders et al., 2001; Worswick et al., 2013). Improved diabetes management strategies and interventions among healthcare providers are essential to close the quality gap. The purpose of this evidenced-based practice (EBP) project was to prompt providers to adhere to diabetes care guidelines using a paper point-of-care reminder over a 12-week period. Provider performance rates covering four specific guidelines were measured: HbA1c, microalbuminuria, diabetic …

Improving Caregiver Health Literacy Of Pediatric Febrile Illness: A Patient Care Initiative, Rebecca T. Shipley

DNP Final Reports

Background: Pediatric fever, though typically harmless and incredibly common, can cause substantial fear and anxiety for caregivers unfamiliar with how to manage or treat this condition at home. Studies evaluating pediatric emergency department (ED) rates have repeatedly found fever to be a leading reason for clinical evaluation. Local EDs record percentages as high as 40% of pediatric patients seek evaluation primarily for fever. Purpose: Provide educational resources for high-risk populations to reference at home regarding fever so that avoidable ED visits decreased and caregiver knowledge of fever improved. Methods: An educational program was implemented at a pediatric primary care clinic …

Decreasing Hospitalization In Infants, William Hang

MSN Capstone Projects

Infants are the most vulnerable population at risk for serious diseases. Respiratory syncytial virus (RSV) is a disease that can be detrimental in infants because of their immature lungs and immune system. Palivizumab, a humanized monoclonal antibody medication, given every 28-30 days has been shown to reduces RSV symptoms and decrease rates of hospitalization by 15%. By reducing the rate of hospital stay, it will also reduce cost.

Description Of The Attitudes, Knowledge And Beliefs On Marijuana In Undergraduate Students Compared To Nursing Undergraduate Students, Maifrak Sobrino

Honors Scholar Theses

Introduction: The use of marijuana has drastically increased over the years. Not only is marijuana being used to treat personal symptoms, but some women use marijuana to manage pregnancy-related symptoms.

Objective: To discover the knowledge, attitudes, and beliefs of marijuana in the undergraduate student population at the University of Connecticut.

Method: A cross sectional study conducted through Qualtrics using a 15-questions survey, including 5-point Likert scale questions and 5 yes/no questions.

Result: Forty-nine non-nursing students completed the survey. Non-nursing students in comparison to the population as a whole agreed that marijuana use was okay (M = 3.959, SD = …

Attitudes, Knowledge And Beliefs On Marijuana Use In Pregnant Women In Undergraduate Nursing Students, Jordyn Witkins

Honors Scholar Theses

Introduction: Due to the decriminalization of marijuana use by states in the United States, marijuana use has drastically increased in the general populations and in women who are pregnant. During prenatal care, nurses provide education about pregnancy and fetal development.

Objective: This study explore the attitudes, knowledge and beliefs of undergraduate nursing students on marijuana use for individuals and during pregnancy.

Method: The study design was cross-sectional survey with 15-question survey using Likert scale and yes/no questions. Nursing students and non-nursing undergraduate students responses were compared.

Results: Sixty-four nursing students (female, n=50) completed the survey. Nursing students in comparison to …

Dying Well: Improving End-Of-Life For Those Affected By Life-Limiting Illness, Fawna R. Allen

MSN Capstone Projects

Healthcare at End-of-life (EoL) in the older adult with a life-limiting illness is often crisis-driven, incongruent with patient and family preferences, and futile. Advance care planning (ACP) is an effective means of aligning EoL goals of care to values and preferences. ACP near EoL in the United States healthcare system is frequently under-utilized and fragmented. Without timely communication and education regarding EoL care options patients and their families are susceptible to spending their last days consumed by ineffective and potentially painful treatments. Alignment of goals of care with patient and family preferences has been shown to reduce crisis-driven care and …

Continuous Glucose Monitors To Decrease Hypoglycemia, Sara B. Woodcock

MSN Capstone Projects

Diabetes is a disease that affects millions of people from children to older adults. There is no cure, although it can be managed to prevent complications. Education of student nurses is where they are born and raised to become nurses who save and change lives. Teaching student nurses in depth about diabetes as a disease and the treatments that best fit their specific needs is where educating patients begins. Learning about a secondary option for blood glucose checks can make all the difference for several patients. Multiple finger sticks daily has been the leading way to check blood sugar for …

Patient With Questions About Cancer Risk, Deborah O. Himes, Jennie Vagher

Faculty Publications

Primary care nurse practitioners routinely care for patients with personal or family histories of cancer. Approximately 5% to 10% of all cancers are related to hereditary cancer syndromes (HCSs), which cause an increased risk for developing more cancers and cancers at earlier ages than the general population. Nurse practitioners in primary care must become comfortable with identifying patients at risk for HCSs. Ordering genetic tests can be a challenge because the number of genetic tests available is growing at a rapid pace. This case highlights a woman who survived breast cancer at age 25 and basal cell carcinoma at age …

Home Telemonitoring In Heart Failure, William Huff

MSN Capstone Projects

Heart failure (HF) exacerbation is a major source of hospitalization, mortality, and healthcare cost to home health agencies. Unmonitored accumulative fluid retention between skilled nurse visits, base knowledge deficits in HF pathophysiology and dietary restrictions, and lack of basic monitoring equipment such weighing scales are primary contributors to HF related hospitalizations in the home health setting. It has been discovered that early recognition of decompensating HF can reduce or eliminate HF related hospitalization, mortality, and healthcare costs associated with the management of exacerbation. When a patient is sent to the emergency room (ER) for fluid overload secondary to HF, massive …

Hpv Vaccination Knowledge, Attitudes, And Uptake In College Nursing Students, Joanna Marie Plumb, Jeannie Giese, Martha Buckner, David Phillippi, Robin Cobb

DNP Projects

Background: The human papillomavirus (HPV) is a preventable, sexually transmitted infection. The vaccines for HPV are safe and effective, but previous research demonstrated that nursing students have low knowledge levels and vaccine uptake. Low knowledge and attitude levels in nurses and nurse practitioners can influence parental and patient decision making for HPV vaccination. Purpose: The purpose of this scholarly project was to evaluate HPV knowledge and attitudes and their association with vaccination uptake in college nursing students. There is limited research in the United States on HPV knowledge, attitudes, and uptake of the vaccine among nursing students. Methods: This project …

Cultivating Appropriate Prescribing In A Primary Care House Calls Practice: A Quality Improvement Project, Sarah J. Marzolf

Doctor of Nursing Practice Projects

Problem Description: Polypharmacy in the frail elderly can lead to suboptimal management of medical issues. Primary Care Providers (PCPs) often lack knowledge of best practices regarding deprescribing and lack a systematic process for assessing mediation appropriateness. A quality improvement project was developed and executed at Housecall Providers, a home-based primary care practice in Portland, Oregon to facilitate the incorporation of deprescribing into daily practice.

Interventions: Following a literature review, a curriculum was developed and utilized during an educational intervention for PCPs regarding deprescribing best practices. A system for introducing new PCPs to evidence-based deprescribing for the frail elderly. This information …