Family Practice Nursing Commons^™

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 …

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 Diabetes Self-Management Skills Among Adults With Type 2 Diabetes Through Weekly Education, Carthia Joachim

Dissertations

Type 2 Diabetes Mellitus is one of the major health issues worldwide, which has led to many health complications, such as cardiovascular disease, nerve damage that leads to limb amputation, kidney damage, and even death (Sameer et al., 2020). Lack of self-care management is one of the reasons diabetes is becoming such an issue in society. Studies have shown that T2DM outcomes can be improved by implementing diabetes self-management education (DSME) (Hailu et al., 2019). The study evaluated the effectiveness of DSME intervention in adult patients with T2DM over 12 weeks in Orlando, Florida. Using a structured education program, the …

Effectiveness Of Eucalyptus For Pain Management: An Integrative Review, Taylor Stone, Jennifer Tran

Master's Projects

This integrative review examines eucalyptus essential oil effectiveness for pain, particularly as an alternative to opioids. An extensive literature search was conducted across multiple databases, including Joanna Briggs Institue, Cochrane, CINAHL, PubMed, and Scopus, focusing on studies examining eucalyptus oil’s analgesic properties, along with its effectiveness when used alone or in conjunction with complementary therapies like massage and acupuncture. Analysis identified three key themes: (1) the effectiveness of eucalyptus oil in pain reduction across various acute and chronic pain conditions, (2) its role in potentially reducing reliance on pharmaceutical pain relief, and (3) its capacity to enhance the effectiveness of …

Relationship Of Stress, Family, And Social Support, And Job Satisfaction To Burnout Among Family Nurse Practitioners Employed In Primary Care Clinics In Mississippi, Laura-Jean Scott Brooks

Dissertations

In the realm of healthcare, burnout is the invisible monster that has infiltrated every facet of the industry with grossly visible results. From provider turnover to patient errors, burnout has lifelong effects on the healthcare provider and patient care. This researcher seeks to study variables and the relationship to burnout among Family Nurse Practitioners who practice in primary care in Mississippi. The Review of the Literature demonstrated a lack of findings in burnout among family nurse practitioners. Most of the literature reviewed focused on burnout among registered nurses. The guiding hypothesis of the research study was that social and family …

Reducing Congestive Heart Failure Readmissions Through Discharge Planning And Education, Coewonda Burse

Doctoral Projects

Chronic heart failure (CHF) is a widespread problem among individuals, which, at the same time, consumes a considerable share of global healthcare demand. CHF management poses a persistent issue mainly due to the short interval of hospital readmissions four weeks after discharge, which indicates deficiencies in care transitions and patient education. This doctoral project addresses this topic and evaluates whether implementing patient-specific education and discharge planning programs can decrease CHF-associated hospital readmissions. To investigate the phenomenon, the DNP student completed a retrospective chart review, found an intervention, implemented said intervention, and then evaluated the intervention's effectiveness versus interventions already in …

Prescription For Change: Tackling Inappropriate Antibiotic Use In Urgent Care Settings, Lachundra Mosley

Doctoral Projects

A pressing global health issue that significantly contributes to antibiotic resistance is the inappropriate antibiotic prescribing for Upper Respiratory Infections (URI’s) in urgent care settings (World Health Organization [WHO], 2022). The purpose of this doctoral project was to reduce inappropriate antibiotic prescriptions for URI at an urgent care in D’Iberville, Mississippi through the implementation of an educational pamphlet.

A pre-post intervention project was conducted, collecting data on antibiotic prescribing practices via retrospective chart reviews before and after the educational intervention. Data was collected using a researcher developed screening tool based on Evidence based guidelines to distinguish viral vs bacterial infections. …

Obstructive Sleep Apnea And Obesity: How Weight Loss Improves Sleep Apnea Severity And Quality Of Life - An Integrative Review, Hannah Wilson, Neda Akbarshahi

Master's Projects

Introduction: With the growing prevalence of OSA due to the obesity epidemic, there is an urgent need to update treatment regimens. While CPAP continues to be the gold standard of OSA care, challenges with adherence and limited access to effective weight management strategies often impede care. The complex bidirectional relationship between obesity and OSA highlights the importance of addressing weight management in this patient population to help mitigate cardiometabolic risks. Personalized weight loss therapies should be integrated into standard OSA treatment regimens to reduce OSA severity, reduce comorbid conditions, and improve quality of life.

Aim: The objective of this integrative …

Munchausen Syndrome By Proxy Presentation, Giovanna Tomassoni, Meredith Mackenzie

Master's Projects

Munchausen syndrome by proxy (MSBP) is a serious form of child abuse in which the perpetrator is typically the victim’s maternal caregiver. Assessing for MSBP can be very challenging for medical providers due to symptom mimicry and a dearth of information about the disorder. This Integrative Review seeks to shine a light on common symptomatology of MSBP and to make sure that providers leave it on the differential diagnosis until alternative diagnoses can effectively exclude it. A total of 240 records from online databases were reviewing for content, currency, and rigor. This search was narrowed to 10 records for in-depth …

Advance Care Planning In Rehabilitation: Training Nurses And Social Workers To Facilitate Discussions, Celeste Christiansen

Student Scholarly Projects

Practice Problem: Patients and healthcare workers fail to hold advance care planning (ACP) discussions. Social workers perceive a lack of time and feel unprepared to hold ACP conversations.

PICOT: The PICOT question that guided this project was: Do patients in acute inpatient rehabilitation (P) who receive education and resources about ACP from trained nurses and social workers (I) accept and participate in ACP (O) compared to prior standards of care (C) while on the rehabilitation unit (T)?

Evidence: The public and healthcare workers have limited knowledge of ACPs and their role in these discussions. People are more likely to hold …

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., …

Best Practice Toolkit For Increasing Colorectal Cancer Screenings In At-Risk Adults, Zoe Windfelder

Student Scholarly Projects

Adult individuals at risk for colorectal cancer (CRC) do not have a direct, accessible best-practice toolkit to follow for screening measures. Research showed that at least three guidelines (i.e., American Cancer Society [ACS], American College of Gastroenterology [ACG], and U.S. Preventive Services Task Forces [USPSTF]) are used interchangeably daily by interprofessional staff for individuals with average to high-risk variables. The project was guided by the following PICOT question: For interprofessional staff supporting the at-risk adult population for colorectal cancer (P), how does the development of a best practice for coordination of care toolkit (I) compared to no structured program strategy …

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 …

Interventions Aimed To Reduce Hospital Admissions In Patients With Cardiovascular Disease Related To Substance Use Disorder, Hannah Lambert, Kayla Landaverde

Master's Projects

Heart failure (HF) and substance use disorder (SUD) are both growing epidemics in the United States. When combined, patients with concurrent substance abuse and heart failure may present with various cardiac complaints such as chest pain, hypertension, and shortness of breath. There are little to few studies specifically evaluating interventions for decompensated heart failure to counteract the rising rates of cardiovascular issues associated with SUD. This review aims to investigate the effects of interventions targeted to prevent hospital readmission in patients with congestive heart failure associated with substance use disorder. An integrative review methodology was applied to gain an inclusive …

Mental Fatigue And Self-Care In Informal Oncology Caregivers: A Descriptive Mixed Methods Study, Megan Wayne

MUSC Theses and Dissertations

Purpose:

This dissertation study aimed to enhance understanding of informal caregiver wellbeing by exploring the presence of mental fatigue, the relationships among mental fatigue, self-care, and informal oncology caregiver quality of life (QOL), and determining whether differences exist in self-care engagement and QOL between caregivers who report high and low levels mental fatigue.

Problem:

Healthcare is becoming increasingly reliant on informal caregivers for the management and care of individuals with serious illnesses such as cancer. Previous research has shown that informal caregivers routinely experience many negative effects as a result of providing care including decreased mental health and …

Enhancing Clinical Staff Knowledge And Skills In Ankle-Brachial Index (Abi) Measurements: A Training Intervention Study In A Small Family Medicine Clinic, Christopher Avellanet Manzano

Doctor of Nursing Practice Projects

Background

Peripheral arterial disease (PAD) is a common yet often underdiagnosed condition that can lead to serious complications. This study aimed to evaluate the impact of an Ankle-Brachial Index (ABI) education training program on clinical staff's referral rates, accuracy in performing ABI measurements, knowledge regarding PAD, and confidence levels in a small family medicine clinic in Dallas.

Method

The study utilized a pre- and post-intervention design. Clinical staff participated in a structured ABI training program, after which referral rates to vascular specialists were measured alongside evaluations of accuracy, knowledge, and confidence levels. The paired t-test was employed to analyze the …

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 …

Comparing Costs And Predictors Of Low-Value Healthcare Service Use Among Primary Care Nurse Practitioners In The Southwest United States, Sara B. Nugent

Nursing ETDs

Low-value healthcare services (LVHSs) are unsupported by current evidence, associated with harmful patient outcomes, and equate to over $100 billion in wasteful spending annually. The aims of this descriptive, comparative study were to establish baseline prevalence and costs associated with LVHS use among primary care nurse practitioners (NPs), and to test the influence of different geographical regions and patient populations. A secondary data analysis of the Merative™ MarketScan® 2021 databases was conducted. LVHS prevalence was lower or fairly equal to that of other studies, and direct claim costs were very-low cost. Extremely high low-value lumbar radiographic imaging claim costs were …

Trauma-Informed Care: A Therapeutic Approach In Communication, Nicole A. Leonce

DNP Qualifying Manuscripts

As medical providers, it is crucial to use therapeutic communication when building relationships with patients. Bias, stigma, and judgment often manifest through a provider’s body language and choice of words, exacerbating patient trauma and leading to health disparities. Trauma-informed care (TIC) addresses these issues by emphasizing respect, compassion, and empathy. TIC has been extensively studied in high-income regions such as Australia, Europe and the United States, but its application in low- and middle-income countries (LMIC) such as Kenya, is less understood. The aim of this study was to assess the knowledge, attitudes, and skills of nurses working in a rural …