Public Health and Community Nursing Commons^™

Implementing The Morisky Medication Adherence Scale To Improve Medication Adherence In Patients With Hiv And Mental Illness, Kyle Ransom

Doctor of Nursing Practice Final Project Abstract

PURPOSE The purpose of this scholarly project was to implement a standardized process for assessing patient medication adherence through the use of a high-quality self-report questionnaire.

BACKGROUND The project was implemented at a federally funded outpatient HIV specialty clinic.

METHODOLOGY Patients seen by the clinic’s psychiatric/mental health nurse practitioners completed the Morisky Medication Adherence Scale during the nurse triage encounter. Patients who scored poorly (below 6) were then referred to the clinic’s interprofessional team (e.g., social workers and pharmacists) to address barriers to medication adherence. Medication adherence was measured using data collected from the on-site pharmacy records in order to …

Naloxone Prescribing At Hospital Discharge: A Quality Improvement Initiative, Timothy Ford

Doctors of Nursing Practice (DNP) Final Projects, 2020-current

Opioid overdose deaths remain one of the largest public health challenges in the United States. Naloxone allocation is an important tool to help combat opioid overdose deaths. The literature supports that hospitalized patients are generally receptive to receiving naloxone and opioid education and interdisciplinary teams working together can help facilitate identification of high-risk patients for naloxone allocation. This quality improvement change, guided by the IHI Triple Aims and Model for Healthcare Improvement frameworks, sought to increase the rate of patients leaving the Hospital Medicine Service with naloxone. To accomplish this, during the target units’ daily interdisciplinary rounds, providers were prompted …

Implementation Of A Food Security Program To Reduce Hypertension At A Primary Care Clinic, Maribel Ballesteros

Master's Projects and Capstones

The food security program aims to reduce hypertension and food insecurity by increasing access to fresh fruits and vegetables. Although food insecurity is a growing public health issue, the food security program experienced significantly low enrollment compared to projected values. The quality improvement project was conducted in an adult medicine department in a primary care clinic in San Francisco serving the Latinx community. To address the issue of low program enrollment, a comprehensive educational food security program flyer was developed containing program information, including frequently asked questions. The flyer aimed to increase program enrollments by increasing program education. Fifty flyers …

Food Security And Its Impact On Hypertension In Urban Communities, Lauren M. Nobriga

Master's Projects and Capstones

The Quality Improvement Team proposed an intervention to increase enrollment in the Food Security Program, a six-month initiative that provides vouchers redeemable for fruits and vegetables. Long-term impacts of this Program include an improved food economy and enhanced patient disease management autonomy. This project aimed to increase the percentage of eligible adult medicine clinic patients enrolled in the Food Security Program by 25%, or 11 patients per month, based on the mean enrollment for the first four months of the Program (May to August) of nine patients. The intervention was based on bi-monthly performance reports, making the goal include enrolling …

Improving Food Security To Decrease Hypertension At An Urban Community Clinic, Christine S. Villalta

Master's Projects and Capstones

Diet and lifestyle changes have been proven to reduce blood pressure in patients with hypertension, and a key dietary approach aligned with this recommendation is the DASH diet, which includes consuming fruits and vegetables. Food insecurity, defined as lacking enough safe, nutritious food to maintain an active and healthy life, is a growing crisis in the United States, affecting 13.5% of U.S. households in 2023. This is especially significant for those whose chronic disease management depends on the accessibility of healthy food. An urban community clinic implemented a Food Security Program to decrease food insecurity and reduce hypertension among their …

Addressing Alcohol Use Disorder In The Outpatient Indigenous Health Clinic Setting, Kylie M. Timmerman

Doctor of Nursing Practice (DNP) Projects

Background: Alcohol use disorder disproportionately impacts American Indian and Alaska Native (AIAN) populations at higher rates of disease morbidity and mortality. In the primary care setting, few treatment resources are available to patients outside of medication-only options.

Local Problem: While the intervention site (rural Tribal Federally Qualified Health Center [FQHC]) was known to have a well-established medication-assisted treatment (MAT) program for opiate use disorder (OUD), the was a need for alcohol use disorder (AUD) resources.

Methods: A review of current evidence was conducted to explore best practices for addressing AUD in the AIAN outpatient clinic setting.

Intervention(s): A quality improvement …

Chronic Disease Screening And Detection In Vulnerable Populations, Courtney J. Seman, Hussein Hadid, Tania Jaimes, Robert Walls

Master's Projects and Capstones

This quality improvement project aims to address gaps in chronic disease screening by implementing standardized protocols for diabetes, hypertension, vision impairment, and scoliosis within the University of San Francisco (USF) Nurse-Led Clinic in Orange County. Problem: The clinic identified a lack of screening practices, which limited early detection and intervention for two specific vulnerable populations. Context: The clinic serves two high-risk groups: older adults, including formerly homeless individuals, and children in two local grade schools. These populations face significant healthcare disparities, making early detection of chronic conditions critical. Interventions: Guided by Kotter’s Change Theory, the project developed and implemented evidence-based …

Improving Performance And Documentation Of The Bedside Mobility Assessment Tool, Joseph P. Chellew

Master's Projects and Capstones

Objectives: Decreased patient mobility is associated with negative health outcomes including decreased functional capacity, pressure injuries, deep vein thrombosis, and bloodstream infections (Yasmeen et al., 2020). Early and increased mobilization mitigates these complications and is associated with positive outcomes (Wang et al., 2020). The Bedside Mobility Assessment Tool 2.0 (BMAT) is a mobility assessment that guides the selection of equipment to safely mobilize patients (Boynton et al., 2020). Aim: This quality improvement project aims to increase BMAT documentation compliance by 10% in three medical-surgical units at Hospital A where only 31.3% of patients were assessed per day using the BMAT. …

Increasing Access To Fresh Fruits And Vegetables At An Urban Clinic: A Quality Improvement Project, Jordan Michael Leahy

Master's Projects and Capstones

The microsystem setting for this quality improvement project is an adult health unit at one of five safety net clinics housed within a macrosystem in a large urban setting in Northern California serving a low-income, predominantly Hispanic population. Professionals involved in the delivery of the food security program include patient support services, medical assistants, case managers, health promoters, registered nurses, and providers. With enrollment in clinic’s food security program significantly lower than program goals, clinical site stakeholders sought to identify and address gaps in delivery. This quality improvement aimed to improve the screening process to increase the percentage of eligible …

Consent, Healthy Relationships, And Sexual Misconduct Education, Bergen Babich, Dinorah Blanco Reyes, Samantha Campbell, Balkhita Mweru, Spencer Roth, Alyanna Velasco

Nursing Leadership in Community Engagement Projects

Introduction

Our team of nursing students collaborated with a university's security office and health services to educate the campus community on sexual assault and gender-based violence. According to the University’s Annual Security and Fire Safety Report, there was a 550% increase in rape cases from 2022 to 2023 (personal communication, 2024). This increase in rape cases indicated a need for increased education and awareness of sexual assault and gender-based violence. Our educational sessions aimed to provide the campus community with education and resources on sexual misconduct and consent to promote healthier relationships on campus.

Background

The population that we served …

Increasing Health Literacy Within The Unhoused Population, Alyse Mk Abraham, Zoe J. Foucaultt, Sean P. Sieber, Simran Gill, Andrew Kang, Fatou Goudiaby

Nursing Leadership in Community Engagement Projects

Nursing Leadership Executive Summary

The unhoused population in Washington State increased by 12% from January 2022 to January 2023, underscoring a growing regional crisis (Washington State Department of Commerce, 2024). To serve this population, we partnered with an agency in Western Washington. In collaboration with the agency’s health services administrative director, we developed a multilingual handout on healthcare and insurance options to improve health literacy.

Our project involved a windshield survey, demographic analysis, evidence-based research, and collaboration with translators to ensure accessibility. This paper outlines the project’s development, research process, creation of the handout, and its intended impact.

Background

A …

Stress Management Through Educational Coping Techniques, Margaret Nikitchuk, Maddy Politeo, Sarah Hall, Ben Pham, David Kumar, Kiana George

Nursing Leadership in Community Engagement Projects

Executive Summary

According to the United States Census Bureau, Seattle reported the highest amount of people with stress in the United States with 54.5% (reported by adults) saying they felt ‘nervous, anxious or on edge’ for at least several days during the past two weeks” (Swedish, 2024). Many residents in Seattle cope with stress in unhealthy ways. For instance, in Seattle-Tacoma-Bellevue MSA, 19% of individuals aged 12 or older used illicit drugs, compared to the national rate of 14.7% (SAMHSA, 2012). Additionally, 22.5% of this population engaged in binge alcohol use at least once in the past month (SAMHSA, 2012). …

Take Charge Of Your Health: Start With Your Smile, Jordan L. Lacey, Brizette O. Owusu, Sophia Gardner, Madeline Whitehead, Haeun Park, May Ligno

Nursing Leadership in Community Engagement Projects

Take Charge of Your Health: Start with Your Smile

Oral health is a fundamental component of overall health, yet it is often neglected-particularly among vulnerable populations like houseless individuals (Freitas et al., 2019). Houseless individuals face numerous barriers to accessing healthcare, with dental services being limited. This lack of access contributes to a higher prevalence of oral diseases, which if left untreated, can lead to severe complications. Poor oral health doesn’t just affect the mouth; it negatively impacts one’s overall systemic health, psychosocial well-being, and quality of life (Csikar et al., 2019).

As nursing students engaged in a Community Health …

Health Services Monthly Educational Newsletter To Parents/Guardians, Dena L. Hinkle, Jennifer L. Fisher, Emily Garnett, Chelsea K. Mckee

Nursing Department Graduate Presentations/Conferences

This health services newsletter was created as an educational and information tool for parents/guardians of Will County School District 92. The intention of this project was to increase student compliance with health requirements, improve parental/guardian education regarding student health, and provide necessary student health education topics. The project began by completing a literature review which allowed for a thorough survey of existing information. The theoretical framework Whole School, Whole Community, Whole Child (WSCC) serves as the foundation for this proposal, along with Pender’s Health Promotion Model and the School Nursing Practice Framework. The three graduate nursing students determined important educational …

Health Education Curriculum Effectiveness And The Role Of The School Nurse, Dena L. Hinkle, Jennifer L. Kilgos-Conwell, Dipika C. Patel, Christina R. Segal

Nursing Department Graduate Presentations/Conferences

Background: The National Association of School Nurses (NASN) identifies the teaching of health promotion, health literacy, and disease prevention as one of the practice principles of school nurses (NASN, 2024). The aim of this project was to examine how health education topics and curriculum in school districts is determined, who is teaching the curriculum, and if there is a role for the school nurse in the development, collaboration or teaching of the curriculum.

Purpose: The project investigated if school nurses are involved in the selection and/or teaching of the curriculum chosen by the district. Input from school nurses and physical …

Prepared To Protect: Improving Cardiac Emergency Response In Youth Club Sports, Melissa Garcia

Nursing | Student Research Posters

Sudden cardiac arrest (SCA) is a medical emergency where the heart unexpectedly stops beating due to an electrical malfunction. A person experiencing a cardiac arrest collapses, loses consciousness, and ceases breathing (American Heart Association, 2022).

Exercise offers numerous benefits to the cardiovascular system and a person’s overall health. However, there are incidents of sports-related cardiac arrest in apparently healthy athletes, including children and young adults. Athletes may be exposed to dehydration, adrenic surges, electrolyte imbalances, acid/base disturbances, and trauma which increases their risk of experiencing a cardiac event (Wasfy et al., 2016).

Sudden cardiac arrest is the leading cause of …

Management Of Possible Serious Bacterial Infections In Young Infants Where Referral Is Not Possible In The Context Of Existing Health System Structure In Mbeya, Tanzania: Experience And Lessons From The End Line Assessment, Esther Ngadaya, Alexander Manu, Mary Mmweteni, Dorica Burengelo, Doreen Philbert, Gibson Kagaruki, Kahabi Isangula, Mbazi Senkoro, Godfather Kimaro, Amos Kahwa

School of Nursing & Midwifery, East Africa

Severe bacterial infections (SBIs) are a leading cause of neonatal deaths in low- and middle-income countries. World Health Organization’s (WHO’s) guideline for outpatient management of danger signs indicating possible serious bacterial infections (PSBI) when referral is not possible was adopted by three pilot district councils in Mbeya Region, in Tanzania (Busekelo, Kyela and Mbarali Districts) in 2018 (the PSBI project). This study documented changes in practice during the PSBI project, and lessons learned. A cross-sectional study was conducted using both qualitative and quantitative data collection methods between July 2021 and January 2022, post-implementation. The study participants comprised stakeholders, health workers, …

Effectiveness Of Clinical Training In Influencing The Outcome Of Visual Inspection With Acetic Acid In Selected Facilities At A County In Kenya, Evah Maina, Abednego Ongeso, Nancy Maingi

School of Nursing & Midwifery, East Africa

Background: Cervical cancer remains a major health concern in developing countries, primarily due to the presence of human papillomavirus (HPV) types 16 and 18. Visual Inspection with Acetic Acid (VIA) is a common and affordable screening method, yet its effectiveness is closely tied to the skills and competency of healthcare providers. This study aimed to assess the impact of clinical training on improving VIA screening outcomes for cervical cancer in a county in Kenya.

Methods: Seven government health facilities equipped with cryotherapy machines were selected, with two healthcare providers sampled from each. A six-day VIA training intervention was conducted, combining …

Evaluating An Evidence-Based Quality Improvement Initiative For Food Insecurity Screening And Referral In Adults With Diabetes Initiating Continuous Glucose Monitor Therapy, Coni Dennis

Graduate Theses, Dissertations, and Capstones

Diabetes affects 37 million people annually in the United States, with direct medical costs exceeding $237 billion per year (American Diabetes Association, 2018; Xu et al., 2018). Complications account for up to 64% of diabetes-related expenses, emphasizing the importance of glycemic stability in preventing costly and debilitating outcomes (Dieleman et al., 2016). Diet and nutrition, essential for glycemic control, are often undermined by food insecurity—defined as inconsistent access to adequate, nutritious food—affecting 16% of adults with diabetes (Casagrande et al., 2022; Kirby et al., 2021). Food insecurity is linked to higher HbA1c levels, increased complications, and hospitalizations (Thomas et al., …

The Effect Of A Virtual Covid-19 Interprofessional Educational Module On Knowledge, Confidence, Attitude, And Practice Among Health And Allied Health Professions Students, Tsu-Yin Wu, Jenni L. Hoffman, Grigoris Argeros, Sarah Lally, Andrea Gossett Zakrajsek, Jillian Graves, Alice Jo Rainville, Olivia Ford, Angela Lukomski, Renuka Roche, John Sonnega, Joan E. Cowdery Phd

Journal of Interprofessional Practice and Collaboration

Purpose: The purpose of this research study was to examine the effect of an innovative, online COVID-19 interprofessional educational module among health and allied health professions students.

Methods: This study utilized a pre- and posttest design with quantitative and qualitative data collected winter 2023 and spring/summer 2023 semesters, and consisted of health and allied health professions students (N=143) from three Midwestern, urban, public universities. Participants completed a pretest, then an IPE module on COVID-19, and a posttest immediately after the educational intervention, and another (the same) posttest one month later. Quantitative and qualitative data were subject to statistical …

Effect Of Telehealth Interventions On Hypertension Management In A Veterans Affairs Community-Based Outpatient Clinic (Cboc), Cherilyn Schumacher

Student Scholarly Projects

Practice Problem: Per U.S. Department of Veterans Affairs (2020), hypertension (HTN) is prevalent in active and retired military personnel with 13% of those in active duty and in “more than one in three Veterans…making it the most common chronic condition for Veterans” (p. 1). Per the Electronic Quality Measure (eQM) portal, a PACT clinic in a CBOC is scoring well below the national and facility benchmarks, showing a need for an intervention that will improve HTN management.

PICOT: For current veteran patients ages 18-85 assigned to a PACT (P), what is the effect of nurse-led telehealth blood pressure …

Evaluation Of A Primary Care Community Health Center’S Mammogram Program In Relation To Current Evidence-Based Practice., Brianna Childress

Doctoral Dissertations & Projects

Breast cancer is the second leading cause of cancer deaths among women over 50 years of age. Although mammograms have been proven to be effective in early detection of breast cancer, compliance rates are declining in the United States making it an objective for Healthy People 2030 to achieve and maintain a national compliance rate of 80.3%. For early detection of breast cancer among women between 50 to 74 years old to occur, an effective breast cancer screening program is vital. To understand why mammogram compliance rates were below the national average at a primary care community health center in …

Management Of Post-Operative Pain In Those With A Drug History, Emelyn Stockton, Maddie Griggs

Scholars Week

Addressing postoperative pain management in patients with a history of opioid abuse is essential for enhancing patient safety and quality care. Implementing evidence-based practices and standardized protocols can reduce the risk of relapse and improve the outcomes for this population. By focusing on staff education and training, healthcare providers can gain the necessary skills to effectively manage pain while minimizing the reliance on opioids. Ultimately, a comprehensive approach that includes alternative therapies and consistent monitoring will foster better recovery experiences for patients.

Central Line-Associated Bloodstream Infection Reduction In Hemodialysis Patients Across 9 Hospitals And 3 States, Nicki Roderman, Kasadi Moore, Shandlie Wilcox, Jennifer Jellerson, Zoey Bridges

HCA Healthcare Journal of Medicine

Background

This quality improvement project was initiated to reduce hospital-acquired catheter-associated bloodstream infections (CLABSI) in hospitalized patients receiving dialysis. A team dedicated to reducing hospital-acquired infections led the implementation of evidence-based interventions across all the included hospitals. This innovative approach demonstrated substantial enhancements in outcomes for patients on hemodialysis.

Methods

To enhance patient safety in patients receiving hemodialysis, new strategies were implemented, including (1) transitioning from a vendor model to an internal model, enabling dialysis program standardization, (2) empowering intensive care nurses with increased autonomy and ownership, (3) transitioning to a standardized dialysis machine, and (4) introducing chlorhexidine gluconate (CHG) …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Preparedness For Practice Of Health Professionals In Papua New Guinea: A Cross-Sectional Survey Of Nurses And Community Health Workers., Mary Kililo, Julie Dopsie, Sulpain Passingan, Julie Kep, Nina Joseph, Russel Kitau, Mary Roroi, Chris Rossiter, Jenny Sim, Di Brown, Caroline Havery, Ali Moloney, Michele Rumsey

Pacific Journal of Health

Introduction

Papua New Guinea (PNG) experiences widespread health inequity and shortage of health professionals, exacerbated by poverty, isolation, gender-based violence and limited infrastructure, transport and accessible services. Nurses and community health workers (CHW) represent 72% of health workforce. However, health professional education programs are outdated and not aligned with national health priorities. We aimed to explore the adequacy of current curricula for nurses and CHWs by examining graduate competencies and preparedness for practice.

Methods

Cross-sectional study with four cohorts: 1) 130 new nurse graduates, 2) 75 nurses who supervised them, 3) 105 new CHW graduates and 4) 65 CHW supervisors. …

Factors Influencing Self-Wound Care Adoption In Singaporean Communities: A Cross-Sectional Survey, Ling Jia Goh, Xiaoli Zhu

Journal of Patient-Centered Research and Reviews

Purpose: Managing wounds often requires frequent clinic visits, posing a burden on both patients and the healthcare system. Shared wound care, which encourages patients to manage dressings at home, has emerged as a potential solution. This study investigates factors influencing self-wound care adoption in Singapore.

Methods: A cross-sectional survey involving 328 participants from six primary healthcare centers was conducted. The survey examined demographics, wound characteristics, and perceptions towards shared wound care using a locally validated questionnaire. Parametric tests and logistic regression were used to analyze the data.

Results: Unlike older participants, younger adults valued time saved through self-care and found …

An Epiq Mass Shelter Training For Public Health Nurses In Georgia To Improve Core Competencies In Disaster Preparedness: A Pilot Study, Ashlie L. Pullen, Sonya Shinhoster

Journal of the Georgia Public Health Association

Background: Research shows that nurses are often ill-prepared for disaster response. A survey conducted by the Georgia Department of Public Health Office of Nursing in April of 2021, demonstrated that 45% of the public health nurses surveyed had never deployed to a mass congregate shelter, and 43% reported they had no formal training related to emergency preparedness or mass sheltering. The purpose of this pilot study was to measure public health nurses’ improvement in familiarity with emergency preparedness and disaster response core competencies as defined by the Emergency Preparedness Information Questionnaire (EPIQ) after a focused educational program and tabletop workshop. …

Predicting Access Barriers And Facilitators To Pediatric Specialty Care Among Children With Complex Chronic Conditions, Elisabeth Vestal

MUSC Theses and Dissertations

Children with complex chronic conditions (CCC) face healthcare inequities when accessing pediatric specialty care. Social or economic barriers may exacerbate the challenges faced by families with a child/children with CCC and include increased geographical distance to specialty services, familial poverty, inadequate neighborhood resources, and food insecurity. Understanding how social and economic factors may impact equitable access to care are essential in improving health outcomes for children with CCC. The first manuscript in this compendium is an integrative review focused on the barriers and facilitators of accessing pediatric specialty care for rural dwelling children with CCC. The second manuscript presents a …

Implementation Of Barcode Medication Administration To Reduce Vaccine Errors, Elizabeth R. Schwarz

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: In the project organization, a large ambulatory medical group, there have been high rates of vaccine administration errors, particularly within family practice locations, which have the most variety of vaccines given.

Aim of the Project: This project aimed to improve the safety of vaccine administration by implementing barcode medication administration (BCMA) in two family practice locations.

Review of the Evidence: BCMA is increasingly recommended for outpatient settings by patient safety groups like the Institute for Safe Medication Practices (2022). Studies show BCMA can save time, improve vaccine data capture and can decrease medication errors by up to 74% (Evanson …