Family Practice Nursing Commons^™

Implementing A Tracking And Referral Follow-Up Process To Increase Screening Colonoscopy Adherence Within A Primary Care Setting, Stephanie Villanueva

Doctor of Nursing Practice

Within the United States, colorectal cancer is the fourth most common cancer diagnosed in both women and men. The American Cancer Society approximated that 97,220 new colon cancer cases and 43,030 rectal cancer cases would occur within 2018. Overall, it was estimated there were approximately 50,630 colorectal cancer deaths in 2018. Despite recommended guidelines, reported screening rates are only 31% to 55%, well below the goal of 75% set by the American Cancer Society. The purpose of this project was to increase preventative colorectal cancer screening referrals and completion of colonoscopies for qualified individuals age 50–75 years within a family …

Screening For Alcohol Use, Misuse, Or Abuse In The Primary Care Setting Using The Audit-C Tool: An Extension Study, Courtney Amanda Minnis

DNP Projects

Abstract

PURPOSE: The purpose of this study was to improve alcohol screening rates in one primary care setting by educating and supporting providers and office staff on the use of the Audit-C alcohol screening tool.

METHODS: This study design was a Quasi-Experimental intervention, one group post-test. Data was collected utilizing a retrospective chart review from the electronic medical records of adults over age 18 years by visit type: New Patient Visit, Annual Visit, or Employee Wellness Exam. Data included: demographic data of patient age, race, gender, the Audit-C score, and whether or not an intervention was performed.

RESULTS: Five providers …

Evaluation Of Depression Screening By Providers For Adult Patients With Type 2 Diabetes In Primary Care, Kristy M. Bryant

DNP Projects

BACKGROUND: Depression in adults with type 2 diabetes can lead to non-adherence to self-management behaviors and treatment recommendations, and ultimately worse health outcomes. Currently, only 50% of adult patients with type 2 diabetes treated in the primary care setting are screened for depression. Without screening for depression, a diagnosis of depression and subsequent treatment is likely to be missed and the patient is more likely to experience worse health outcomes and worse quality of life.

PURPOSE: The purpose of this study was to evaluate impact of provider education on improving screening rates for depression in adult patients with type 2 …

What’S Keeping America’S Heroes Awake? Screening For Obstructive Sleep Apnea In Male Veterans With Hypertension And Diabetes, Aaron James Stirling

Doctor of Nursing Practice Final Manuscripts

Purpose: To reduce cardiovascular risk through optimal obstructive sleep apnea (OSA) management with proactive screening utilizing the Epworth Sleepiness Scale (ESS) in male Veterans with hypertension (HTN) and diabetes mellitus (DM).

Background: OSA is a common finding in primary care, with 1 in 5 adults feeling its effects: excessive sleepiness, impaired cognition, reduced quality of life and increased mortality. Unmanaged OSA has been highly correlated with increased cardiac risk in populations with chronic diseases such as HTN and DM. Fortunately, identification and treatment of OSA has been shown to improve cardiovascular outcomes and reduce mortality. Evidence supports outpatient screening to …

Evaluating The Effect Of A Nurse Navigator In Increasing Colorectal Screening, Christine Njogu

DNP Projects

PURPOSE: The purpose of this study is to evaluate the effectiveness of a nurse navigator in increasing colorectal (CRC) screening in primary care setting.

METHODS: This was a descriptive retrospective study of the effect of nurse navigators in increasing colorectal screening in primary care settings within Jefferson county and its surrounding counties. The sample consisted of 200 patient chart reviews for the period of September 1st through December 31st, 2017. Rates of colorectal screening were compared in those who received a nurse navigator call and those who did not.

RESULTS: Overall screening rates were 44.6%. A distinct increase in screening …

Vietnamese American Women’S Beliefs And Perceptions On Cervical Cancer, Cervical Cancer Screening, And Cancer Prevention Vaccines: A Community-Based Participatory Study, Connie Kim Yen Nguyen-Truong, Kim Quy Vo Nguyen, Thai Hien Nguyen, Tuong Vy Le, Anthony My Truong, Keara Rodela, Rachael Allan

Asian/Pacific Island Nursing Journal

Cervical cancer remains commonly diagnosed in Vietnamese American women. Despite efforts to increase cervical cancer screening among Vietnamese American women, participation rates are persistently lower than the national goal. The objective of this study is to explore beliefs of Vietnamese American women about cervical cancer, cervical cancer screening, and cancer prevention vaccines. A qualitative descriptive investigation captured group perceptions about meaning and beliefs of cervical cancer, screening, and cancer prevention vaccines, and participants’ stories using a community-based participatory research approach.

Forty Vietnamese American women were recruited from the Portland, Oregon metropolitan area into four focus groups. Using a process of …

Increasing Depression Screenings In Adults With Advanced Non-Surgical Heart Failure Using 2013 Accf/Aha Recommendations And Healthy People 2020 Target Goals, Valerie Valencia

Doctor of Nursing Practice

The purpose of this evidence-based practice project was to increase depression screenings in adults with non-surgical advanced heart failure using reliable and valid tools, 2013 American College of Cardiology Foundation/American Heart Association recommendations, and Healthy People 2020 Target Goals as a method to identify and facilitate appropriate mental health referral, patient education, and follow-up for depressive symptoms. Interventions took place June 5, 2017, through August 10, 2017. This intervention project involving 246 adults with advanced heart failure demonstrated that an evidence-based intervention for depression screenings increased the number of patients screened from 5% to 44%. At project completion, 65% of …

Provider Based Interventions To Mitigate Risk For Opioid Pain Medication Abuse Among Adult Patients In A Primary Care Setting, Sheree Lamara Conley-Donaldson

Doctoral Projects

Mental and substance use disorders are predicted to exceed all physical disease processes causing major disability by 2020. Misuse and overdose of opioid pain medications is a significant public health concern in the United States. Approximately 1 in 4 patients receiving prescription opioids in primary care settings struggle with misuse. Half of all opioid prescriptions are written by primary care providers, including nurse practitioners. The purpose of this DNP project was to determine if nurse practitioner providers are implementing evidence-based practice guidelines including screening, brief intervention, and referral to treatment (SBIRT) to mitigate risk of prescription opioid pain medication misuse …

An Evaluation Of Childhood Overweight And Obesity Screening And Management In The Primary Care Setting, Stephanie Horning

DNP Projects

Background-In Kentucky, 19.7% of children ages 6-11 years old are obese ("Center for Disease Control and Prevention (CDC)," 2013). Approximately 50% of these children will become obese adults (Lazarou & Kouta, 2010). It is imperative that interventions are initiated to normalize weight in childhood to offset the long term physical and psychosocial risks associated with obesity.

Purpose-The purpose of this gap analysis was to evaluate the screening and management of childhood overweight and obesity in one of Norton’s healthcare primary care setting.

Methods-The electronic medical records of 35 children aged 10 to 11, who had BMIs > 85 …

Compliance With The 2015 American Diabetes Association Screening Guidelines For Diabetes Mellitus Type 2 In Primary Care, Krista L. Johnson

DNP Projects

Purpose: The purpose of this project was to evaluate provider use of hemoglobin (HgA1c) measurement as a method of screening for Type Two Diabetes Mellitus (T2DM) per the 2015 American Diabetes Association screening guidelines in a multidisciplinary primary care clinic in Kentucky.

Methods: A retrospective electronic medical record review was conducted in a large ambulatory care clinic. A master list was compiled of all patients aged 45-89 years who were seen for any reason the first week of November 2015. A total of 127 records that met inclusion criteria were randomly selected. The proportion of patients who were appropriately screened …

Assessment Of Depression Screening In Women’S Primary Care Clinic, Susanna Gorton

DNP Projects

Purpose: The purpose of this practice inquiry project was to evaluate provider adherence to depression screening documentation in the ambulatory electronic health record (AEHR) before and after changing locations of the depression screening questions within the AEHR. Provider knowledge about depression screening and barriers related to depression screening were also examined.

Methods: A retrospective chart review was completed for patients seen for an annual exam by a physician provider in a women’s primary care clinic. Data collected included demographic data, co-morbid conditions, depression screen documentation (PHQ-2 & PHQ-9), and interventions documented. A questionnaire was sent to providers in the primary …

Documentation Of Smoking History And Adherence To The Uspstf Recommendation For Lung Cancer Screening: A Retrospective Chart Review, Laura A. Golden

DNP Projects

Purpose: The purpose of this project was to evaluate provider compliance with documentation of smoking history and, if criteria met, referral for lung cancer screening as recommended by the United States Preventive Services Task Force in 2013.

Methods: A retrospective chart review was conducted using an electronic medical record (EMR) at a large, rural community family practice clinic. Patients meeting inclusion criteria of having a smoking history (current or past) of 30 pack years, aged 55 to 80 years, and no history of lung cancer diagnosis were included for randomization. One hundred patients were selected from 300 randomized charts; five …

Retrospective Analysis Of Body Mass Index Screening And Obesity Counseling In A Primary Care Setting: Comparative Analysis Of Demographic Variables And Co-Morbidities, Christina Fisher Higdon

DNP Projects

Study Purpose: To assess obesity screening and counseling in patients at annual wellness exams in an urban primary care clinic. Specific aims of the study: determine percentage of patients with documented body mass index (BMI), ICD-9/ICD-10 diagnosis of overweight or obesity, documentation of education or a follow-up plan for weight management, follow-up visit for weight loss and documentation by provider, and comparative analysis of co-morbidities and demographic variables during well-exam visits.

Target Population and Measures: Adults over the age of 18 in an urban primary care clinic with a BMI greater than 25 kilograms (kg)/meters squared (m2). BMI screening and …

Evaluating Adherence To Colorectal Cancer Screening, Jaime Bradley-Miller

DNP Projects

Purpose: The purpose of this project and literature review was to determine provider documentation practices of colorectal cancer (CRC) screening, identify the percent of clinic patients who need to be screened, and develop a set of recommendations and targeted interventions which will increase CRC screening rates.

Methods: A retrospective chart review including males and females of all ethnicities between the ages of 45 and 80 was performed in one primary care practice. A randomized sample of 360 office visits between February and November of 2015 were selected, of which 281 met the inclusion and exclusion criteria. Patient demographics and characteristics …

An Assessment Of Current Nicotine Screening Rates And Practices Within Primary Care, Kathryn A. Dunlap

DNP Projects

Purpose: The purpose of this project was to explore the current practices related to nicotine screening in the primary care setting within the Norton Healthcare System. The objectives were to assess: 1) the current compliance rate for nicotine screening and documentation per visit for patients who are seen in a primary care office, and 2) documentation of tobacco cessation counseling and pharmacologic management for patients seen in a primary care office.

Methods: A retrospective chart review was conducted to assess the current compliance rate for nicotine screening and documentation per visit for patients who are seen in a primary care …

Improving Depression Care For Older Home Health Patients, Sarah R. Schirmer

DNP Projects

Rates of depression in older home healthcare (HH) patients are highly prevalent. Although depression in this population is associated with increased rates of re-hospitalization, falls, and suicides, it is frequently under diagnosed and under treated. This Capstone Report examined this problem through three interrelated manuscripts. The first manuscript explored the problem through a review of the literature. This review determined that while there are many barriers to adequate depression care, programs that train clinicians to screen for depression and connect patients to depression care encourage adequate evaluation and treatment and can result in clinically significant changes in depression scores. This …

Dnp Practice Inquiry Project Report: Depression Screening In Primary Care, Mary Kathleen Stafford

DNP Projects

Depression affects many people worldwide and is a leading cause of disability. National guidelines and recommendations have been created that support screening for depression in the primary care setting, however due to many barriers depression screening is often not performed or documented. This capstone project consists of three manuscripts, which evaluate the lack of depression screening in the primary care setting. The first manuscript is an integrative review of the literature to support depression screening in primary care and to address barriers to depression screening. The second manuscript is a guideline analysis of a national guideline published by the Institute …