Public Health and Community Nursing Commons^™

The Mental Health Experience Among Parents Of Children With Autism, Thao Tran

Doctoral Projects

Parents of children diagnosed with autism spectrum disorder (ASD) face challenges, stress, and mental health issues than parents of children without autism. Mental health experience of parents in underserved communities are not adequately studied. This qualitative study used a phenomenological approach to understand the mental health experience of eight parent caregivers residing in San Joaquin Valley, California. All parents reported the journey was stressful but not all parents described the point when they received the diagnosis as being more stressful than before and after the ASD diagnosis. Parents’ responses to the semi-structured interview that assesses for the degree of ambiguous …

Comparison Of A Self-Audit Tool To Accrediting Health Care Agencies’ Standards Of Care In A Corrections Setting, Matthew C. Widerman

Doctoral Projects

Millions of individuals enter correctional facilities each year and require health services. Inmates are bound to a set of rules, wherein they are thought of as objects of surveillance, punishment, or rehabilitation, rather than as patients. In addition to standards of care defined by national accrediting bodies and state boards of practice, correctional facilities also have state laws that define expected health services for incarcerated persons. All health care providers have a responsibility to provide the highest quality care, but in prisons, patients are still inmates bound to correctional rules. Policies and procedures guide health care practices in correctional facilities, …

Implementing Screening To Assess Readiness To Change In Overweight And Obese Patients At A Patient-Centered Medical Home, Jarrod Gant

Doctoral Projects

Obesity is at epidemic levels within the United States (U.S.), but the Southern U.S. has some of the most obese states. Mississippi (MS) is the most obese state in the country (Robert Wood Johnson Foundation, 2018). Factors such as diet, sedentary lifestyle, cultural influences, and socioeconomic status contribute to the state’s citizens being overweight and obese.

Contributing to the state’s obesity is the fact that MS has more people living in poverty than any other state (Center for American Progress [CAP], 2018). Lacking the ability to afford healthy foods and the ability to afford quality healthcare adds to the state’s …

Implementation Of A Self-Care And Wellness Educational Program Addressing Job Stress Among Child Protective Service Workers, Natonya Murray

Doctoral Projects

Job stress attributed to secondary exposure to trauma and the high work demands put child protective service workers at high risk of developing physical and psychological health problems. The purpose of the project was to develop and implement a self-care and wellness educational program addressing job stress among child protective service workers (CPS) guided by Substance Abuse and Mental Health Science Administration’s (SAMSHA, n.d.b) educational toolkit, Promoting Staff Wellness and Preventing Vicarious Trauma and other Work Force Concerns, the Centers for Disease Control and Prevention’s (CDC, 2019c) section on Adverse Childhood Experiences, and the National Council for Community Behavioral …

Prior Authorizations And Continued Treatment In Addiction Medicine, Wendy Hunting

Doctoral Projects

Introduction: Patients that require medication assisted treatment for opioid addiction can have their treatment delayed through the prior authorization process. A prior authorization is required by many insurance companies and can cause lengthy delays before the drug is approved. The two drugs that were considered for this project were Suboxone® (buprenorphine/naloxone) and Sublocade® (buprenorphine). These drugs are used for the treatment of opiate addiction. The proposed solution to the problem was to use quality improvement methods to implement a tracking and tickler system to improve the approval time from the insurance company.

Objectives: The project goal was to decrease the …

Exploring Ways To Improve Healthcare Access For The Homeless Population In Merced County, Stella Nwasoka Adesokan

Doctoral Projects

Homelessness is a societal dilemma that affects people in the United States and around the globe. Homelessness relates to poor health conditions that affect the living conditions of individuals (Institute for Urban Initiatives, 2018). Chronic and acute illnesses are rampant in this group, most of these illnesses are treatable but accessing healthcare poses a challenge for this vulnerable population. Homeless persons are often unable to access healthcare due to fear and denial of ill health, difficulty in communicating health needs, and low self-esteem (Lamb & Joels, 2014).

In the study, questionnaires were administered to 25 homeless individuals through random sampling. …

Barriers In Health Care In Hmong Men And Women With Cardiac Diseases, Ying Thao

Doctoral Projects

Lauver’s theory of care seeking behaviors is applied to identify perceived barriers to accessing healthcare in Hmong men and women that may influence care seeking behaviors. The purpose of this study is to identify barriers in accessing health care among Hmong men and women ages 50 to 80 with cardiovascular heart disease (CHD) and risk factors for CHD (e.g., diabetes, hyperlipidemia, and hypertension). A quantitative descriptive analysis was used to look at demographic characteristics while a multiple regression analysis was used to statistically compare correlations between barriers to care, risk factors for CHD, sex, and access to health care. The …

Follow-Up Among Homeless Patients At San Francisco General Hospital: Examining The Social Determinants Of Health, Robert Gnat

Doctoral Projects

The San Francisco General Hospital emergency department has a high occurrence of homeless patients that are lost to follow-up after discharge. This Doctor of Nursing Practice project conducted a survey to evaluate the social determinants of health among this population and how they influence the participant’s ability to follow-up. This is the first phase of a three-phase project involving assessment and evaluation. The second and third phases of this project will center on intervention and re-evaluation after intervention. The survey was administered to eligible participants who presented to the emergency department at San Francisco General Hospital. Fifty participants were surveyed …

Pathways To A Sustainable Community Health Worker Program In A Rural Native American Community, Hannah R. Duby

Doctoral Projects

Introduction: American Indian/Alaska Native (AI/AN) people have some of the greatest health disparities of any other citizen group in the U.S. (National Indian Health Board [NIHB], 2018). As liaisons between community members and health services, community health workers (CHWs) play an important role in reducing disparities in AI/AN communities (Indian Health Service [IHS], 2018). CHWs in the organization of interest are not being used to their full potential as the documentation of their care is not accessible to the primary care providers (PCPs) for care coordination and the program is threatened by issues related to sustainability.

Objectives: The purpose of …

Screening For Social Determinants Of Health In Diabetic Patients Served In Primary Healthcare Centers, Hewan K. Chekol

Doctoral Projects

Background: Social Determinants of Health (SDOH), such as food, transportation, housing, and financial status, plays a significant role in a diabetic patient’s health care outcome. However, primary healthcare centers lack a systematic method of identifying patients with unmet social needs in order to provide appropriate referrals to community resources.

Objective: This project seeks to improve the screening methods of SDOH in a midwestern federally qualified primary healthcare center by incorporating an evidence based SDOH screening tool. This SDOH screening tool is tailored towards diabetic patients.

Method: Kotter’s Eight Step Change model guided the implementation process of this quality improvement project. …

Improving A Midwestern Community Mental Health Organization's Smoking Treatment Services For Individuals With Serious Mental Illness, Leah J. Magnuson

Doctoral Projects

Tobacco smoking is the leading cause of preventable death in the United States. Billions of dollars are lost yearly in direct and indirect healthcare costs as well as lost work productivity due to smoking. While smoking rates have declined among those of the general population, they remain high among those with serious mental illness (SMI). Many of those with SMI desire to quit and are able to quit smoking when they are provided with appropriate interventions and resources. It is recommended for those with SMI to receive combined interventions in the form of pharmacotherapy and cognitive behavioral therapy to help …

Implementation Of The Vaccines For Children Program In A Midwest, Urban Clinic Dedicated To The Underserved Population, Akmal Saydazamov

Doctoral Projects

Background: Low immunization rates weaken herd immunity and endanger children. The Safety Net Health Clinic (SNHC) study site serves an underprivileged and refugee population with significantly lower than ideal coverage. Series completion disparities persisted after control for demographic, access-to-care, poverty and language effects (Varan et al, 2016).

Objectives: SNHC implemented the Vaccines for Children (VFC) program in order to increase the vaccination rates among the underserved population.

Methods: As an efficacy study, the project focused on three major areas in the VFC implementation – cost, staff preparedness and patient need. Cost was determined by utilizing electronic medical records (EMR) and …

Development Of A Process For Adoption And Attainment Of Pcmh Recognition Requirements For An Urban Primary Care Clinic, Jamie L. Hendricks

Doctoral Projects

The Centers for Disease Control and Prevention (2017) reported that in 2016, healthcare expenditures in the United States totaled 17.9% of the gross domestic product. Unfortunately, care quality is not reflective of the high costs of care. Models of care delivery like the patient centered medical home (PCMH) have shown promise in addressing these concerns.

This project focused on program development for PCMH adoption at an urban clinic in an effort to improve financial stability and remain competitive. The purpose was to propose a plan for adoption and attainment of PCMH recognition requirements for an urban primary care office.

The …

Using Technology-Driven Patient Communication Appointment Reminders To Improve Uniform Data System Measures In A Federally Qualified Health Center, Ana Torres

Doctoral Projects

Background: Process of meeting Uniform Data System (UDS) measures in a west Michigan Federally Qualified Health Center (FQHC) has several components with different team members sharing responsibility in the process and workflow to document preventative screenings. An evidence-based technology-enhanced patient communication intervention was developed to meet benchmarks for the FQHCs UDS reporting metrics. The purpose of this quality improvement project was to answer the clinical question: Will technology-enhanced communication appointment reminders using automated telephone communication increase rates of screening follow-up visits to improve data reported to UDS at a west Michigan FQHC organization?

Objectives: Increase percentage of screening visits after …

Implementing Use Of The Moss (Michigan Opioid Safety Score) Tool And Interventions To Reduce Opioid-Related Overdose Events In High Risk Patients, Michelle J. Kloss

Doctoral Projects

Opioids are among the most common pharmacological class of therapeutic medications prescribed to alleviate pain across all healthcare settings. However, opioid-related adverse events are a growing problem contributing to an increase in morbidity and mortality. Current hospital practice does not utilize a pre-opioid administration screening tool to assess patient risk of adverse events related to opioid administration. The implementation of the Michigan Opioid Safety Score (MOSS), an evidence-based risk assessment tool which utilizes patient characteristics as well as respiratory assessment for the prediction and early detection of opioid-induced adverse events. This quality improvement project evaluated the effectiveness of the MOSS …

A Need For A Culturally Congruent Obesity Intervention At A Community Safety-Net Clinic, Claudia D. Rivera-Salas

Doctoral Projects

Background: Obesity is an epidemic in the United States which causes numerous chronic conditions and disproportionally impacts underserved populations. The removal of barriers that prevent active lifestyles such as unaffordable facilities and inaccessibility are of primary importance in promoting a healthy lifestyle.

Objectives: Collaboration with community organizations to increase access to culturally congruent nutrition and exercise classes for underserved Latino/Hispanic patients of a Midwestern safety-net clinic to reduce obesity, increase physical activity, and improve dietary habits.

Methods: Assessment of current practices revealed the need for project development. Six-week nutrition education class and exercise classes were held for eligible patients which …

Evaluating The Effectiveness Of Diabetes Class: A Project To Improve Quality Metric Measures, Miriam O. Russell

Doctoral Projects

Background: Diabetes is a significant health issue worldwide. Its increasing prevalence globally and regionally has been documented. Consequently, complications have resulted in higher morbidity and mortality in patients with diabetes (Martin & Lipman, 2013). The lack of education on self-managing diabetes can lead to serious complications. An effective approach, including evaluating and enhancing diabetes education, is necessary to improve diabetes self-management (Johnson & Raterink, 2009).

Objectives: To provide evaluation of a diabetes education class through quality measures and create a toolkit that will enhance the impact on the current diabetes education class.

Methods: A retrospective chart review that analyzes five …

Is There A Relationship Between Limited English Proficiency (Lep), Medication Adherence Behaviors, And Adverse Asthma Outcomes In Hispanic Adults With Moderate To Severe Persistent Asthma?, Archana Kartik Chandra

Doctoral Projects

The effects of LEP are well documented in the literature. LEP decreases medication adherence, causes ineffective communication between patients and providers, and reduces health outcomes. Asthma is known to be misdiagnosed and under-treated in Hispanic adults. There are discrepancies in the literature about the effects of LEP in Hispanic adults with persistent asthma.

The purpose of this study was to determine if the presence of LEP is associated with medication adherence behaviors and adverse asthma outcomes in Hispanic adults with moderate to severe persistent asthma. Hispanic adults with LEP were assessed for asthma outcomes and medication adherence behaviors.

The results …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Improving Adolescent Risk Behavior Screening: Implementation Of The I-Cloud Rapid Assessment Adolescent Preventive Screening (Raaps) Tool, Donna L. Rinker

Doctoral Projects

Adolescents are engaging in risky behaviors earlier contributing to 75% of adolescent morbidity and mortality with unintentional injuries listed as the most common cause of death among this population in the United States. It is reported that engaging in more than one risk behavior will lead to other risk behaviors resulting in the rise of indirect and direct costs in society today. The scholarly project was conducted in response to a midwestern Michigan primary care clinic need to improve the early identification and documentation of adolescent risk behaviors with evidence-based technology screening. The purpose of this quality improvement project was …

Evidence-Based Study Of Medication Compliance Project In Hiv Prevention Using Pre-Exposure Prophylaxis (Prep) Antivirals For Hiv-Negative Males, Ming-Chun Ho

Doctoral Projects

In 2012, emtricitabine/tenofovir was the only Food and Drug Administration-approved medication for pre-exposure prophylaxis (PrEP) used in human immunodeficiency virus (HIV) prevention. To date, there is little research on open-label and mixed-payer characteristics supporting medication compliance of men who have sex with men (MSM). The purpose of this research was to describe individual demographic variables associated with PrEP medication adherence and to examine the effect of a follow-up phone call from a nurse once a month for 3 months. A total of 30 MSM were recruited and data were collected using a demographic questionnaire, medication adherence tool and follow-up phone …

Sexually Transmitted Infection Risk Reduction For College Students, Mary Kathryn Dowling

Doctoral Projects

University students have been assessed through many sexual health lenses, but there is a paucity of research on the sexual health of community college students. This population may provide good access to at-risk youth, and opportunity to reverse steep climbs in sexually transmitted infection (STI) rates. This research project pilot tests a theory-based intervention employing social facilitation to reduce STI risk among college students. Fifty students were recruited from Human Sexuality courses to participate in a 60-minute workshop. Pre- and post-testing measured for change in STI knowledge, attitude towards safer sex, and self-efficacy for engaging in safer sex practices.

A …

Adolescent Sexual Health: Provider Evaluation Of A Sexual History Tool At A School-Based Health Clinic, Gillian Marie Williams

Doctoral Projects

There is a growing concern within the United States in regard to sexual behavior within our adolescent population. Sexually transmitted infections (STIs) have always been a concern, however, there has been a steady increase since 2014 in the three nationally reportable diseases of chlamydia, gonorrhea, and syphilis. According to the CDC (2017), 15-24 years old account for half of all the new STI s. There is a need to provide more sexual health to adolescents during their health visits. It is also imperative to understand the beliefs and attitudes of providers with providing these types of exams and asking questions …

Can Using A Smartphone Application Improve The Ability Of Law Enforcement Officers To Recognize Commercially Sexually Exploited Children And Report Them To Child Welfare Authorities?, Sheree Goldman

Doctoral Projects

The commercial sexual exploitation of children (CSEC) is a crime of abuse that is frequently unrecognized because mandated reporters may be unfamiliar with the indicators. Commercially sexually exploited minors participate in sex acts in exchange for money, goods, or services. At least 200,000 American children are believed to be victims of this crime each year (County Welfare Director Association of California, 2015). Victims often go undiscovered and experience significant health issues. A public health model is used to explain the context of victimization and the need for interdisciplinary collaboration to discover victims and connect them with needed services. A randomized …

School Nurses’ Experience Of Barriers To Care In Children With Type 1 Diabetes, Eden Joseph Donahue

Doctoral Projects

Purpose: The purpose of the study was to gather data on the lived-experience of providing and coordinating type 1 diabetes care in the school setting from school nurses who practice in California. Methodology: A descriptive phenomenological qualitative study design was used to collect data through structured interviews with 13 school nurses. Descriptive coding was used to analyze the interview data. Findings: School nurses face multiple barriers to care when providing type 1 diabetes care in the school setting. The three major themes school nurses encountered were difficulty with care coordination, communication, and parents.

Prevalence And Prevention Of Diabetes In School Age Children: A Parent Education Module, Christine Mary Whitmyer

Doctoral Projects

The Center for Disease Control reports that there continues to be an increasing number of children being diagnosed with childhood-onset Type Two Diabetes Mellitus (T2DM). The recommendation is to provide education to parents regarding the risks and possible risk factors of T2DM, and strategies to prevent and treat these risk factors (Center for Disease Control [CDC], 2014). Educating parents of school age children on T2DM risk factors, and prevention practices may help to slow down this rising number of new cases. The Aim is to provide educational modules that may increase knowledge, which could in-turn change behavior, that may prevent …

African American Men And Ostrich Behavior, Debbie Slack-Gay

Doctoral Projects

This project explores why African American men choose Ostrich Behavior when it comes to health care prevention and maintenance as related to hypertension. The population was African American men, ages18–80, in Northern California. Men were recruited while getting a haircut or waiting for one or after church services. Blood pressure readings were taken and a health questionnaire was administered. The results show that even if hypertension is known, men ages 18–45 go to fewer office visits than African American men in other age groups, and older men tend to seek medical care and take medication if prescribed.

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 …

Sexually Transmitted Infection Prevention In 18 To 24-Year-Old Heterosexual Men: Pilot Study, Susan P. Mckeefrey

Doctoral Projects

The CDC reported that there were over 20 million cases in the United States and half affected young adults, 15 to 25-year olds. Strategies STD prevention have been developed by the CDC but does not include avoiding alcohol or other similar agents in the context of a sexual encounter. The purpose of this study was to assess the effectiveness of STD prevention education intervention by improving Condom Use Self-Efficacy in heterosexually 18 to 24-year old men. It was hypothesized self-efficacy would improve with a face-to-face brief educational intervention. A quasi-experimental, pre-/post-test design with simple randomization of subjects into control and …

Undiagnosed Depression In The Elderly And Healthcare Education, Nancy J. Wynn-Grundy

Doctoral Projects

This descriptive study examined undiagnosed depression in the elderly and how it affects the elderly from retaining healthcare education. It is estimated by 2029, 20% of the United States population will be age 65 and older (Colby & Ortman, 2014). Depression in the elderly who have chronic diseases, is estimated to be undiagnosed up to 40% (Chaoyang et al., 2009). A hallmark symptom of depression is the inability to concentrate. It is unknown if undiagnosed depression will affect the older adult from retaining pertinent healthcare education. The 30 point Geriatric Depression Scale (GDS) was administered to a class of elderly …