Family Practice Nursing Commons^™

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 …

A Cross Cultural Comparison Of Adolescent Sexual Socialization In Family Settings In Four Thai Regions: A Cross Sectional Survey, Ampornpan T้Heeranut, Pongdech Sarakarn, Donlagon Jumparway, Arina Abdulloh, Piches Ruangsuksud, Chaiyun Sakulsriprasert, Bhunyabhadh Chaimay, Linda L. Shield, Alison Hutton, Kesinee Saranrittichai

Journal of Health Research

Background: Sexual socialization is different across cultural contexts due to norms and values including adolescents’ growth & development and characteristics. Patterns of sexual socialization across different cultural contexts and adolescents in Thailand are still unknown. This analytical cross-sectional study aimed to explain and compare 5 patterns of adolescent sexual socialization in Thailand (SSFA): trust, strict, exhaust, review, and general patterns.

Methods: The sample included 1,050 parents living in the same house with their adolescent offspring aged 13-19 years. Stratified cluster randomized sampling was performed to access participants. The instrument used for measuring adolescent sexualization in families with adolescents was …

Evaluation Of An Advanced Practice Clinician Onboarding Program, Sophia Robinson

Student Scholarly Projects

Practice Problem: This project aimed to evaluate the effectiveness of a mentorship-based onboarding program versus a standard program without mentorship.

PICOT: The PICOT question that guided this project was (P), In newly hired APCs did the inclusion of mentorship in the onboarding process (I) lead to higher levels of general self-efficacy compared to standard orientation practices lacking mentorship (C), within an 8-week timeframe (T)?

Evidence: Nine articles were reviewed, revealing that standardized mentorship, structured orientation, and tailored support for professional development are critical strategies to boost confidence and retention among healthcare professionals.

Intervention: A standardized onboarding program that incorporated …

Increasing Breast Cancer Screening Rates Among Women Ages 40 To 74 In An Urban Safety Net Primary Care Clinic: A Quality Improvement Project, Wilder Pinnock

Doctor of Nursing Practice Scholarly Projects

Background and Problem Description: Breast cancer continues to be the most common and second most lethal form of cancer among women in the U.S. Although there have been improvements in breast cancer screening in the US, major disparities persist. The national breast cancer screening rate for the year 2021 was 75.6%; the rate for the underserved and minority population was 54%. This QI project took place at a Federally Qualified Health Center that provides medical care to medically underserved and vulnerable populations.

Purpose and Aim: This project aimed to increase breast cancer screening at the proposed site to optimize early …

Interdisciplinary Medication Reconciliation Approach For Arabic-Speaking Patients, Rebecca Rodman

Dissertations

Abstract

Problem: Limited English Proficiency (LEP), which includes Arabic speakers, presents challenges in healthcare and can impact medication reconciliation and adherence. Interdisciplinary collaboration involving patients and interpreters is crucial for improving medication reconciliation and adherence. This project aimed to examine the impact of an interdisciplinary medication reconciliation approach on medication adherence with Arabic-speaking patients ages 18-99 over three months.

Methods: This quality improvement (QI) pilot project utilized a descriptive cohort design. A translated validated Morisky, Green, and Levine (MGL) adherence survey consisting of four questions was administered pre- and post-implementation to a convenience sample of Arabic-speaking patients 18 years …

Implementation Of Home Blood Pressure Monitoring, Sarah Gutzke

Dissertations

Approximately 48.1% of adults in the United States have high blood pressure. Providers may encourage patients to monitor and log their blood pressure at home. Still, patients often fail to bring this information to appointments, leading to reliance on less comprehensive in-office measurements. This quality improvement project aimed to increase adherence to home blood pressure logs using a Blood Pressure Toolkit. A descriptive, observational design was utilized to record patient adherence of taking home blood pressure measurements and increase the number of patients who brought their blood pressure logs to their healthcare provider visits over two months. A convenience sample …

Evaluation Of A Smoking Cessation Program In Primary Care, Yolanda Duncan-Watt

Dissertations

Abstract

Problem: The adult tobacco smoking rate exceeds 12.5%. The problem is the insufficient attention given to smoking cessation education in low socioeconomic status(SES) communities. There is a lack of access to and awareness of smoking cessation programs for low-income populations.

Methods: This quality improvement (QI) study will use a descriptive, observational approach. A retrospective medical record review will be conducted to determine the rate of individuals who got the smoking cessation intervention and the rate of those who successfully quit one month after the intervention. Data was collected throughout the spring of 2024, during primary care visits and phone …

Improving Transitions In Care Through Early Discharge Planning: A Quality Improvement Initiative., Sarah Markgraf

Doctor of Nursing Practice Papers

Background: A substantial body of evidence has shown transitions in care are one of the weakest links in healthcare networks, especially for older adults with complex comorbidities. Residents receiving short-term rehabilitation (i.e., rehab) transitioning to home from a skilled nursing facility (SNF) are the most vulnerable in the first 30 days post-discharge for adverse resident events, including avoidable rehospitalization. Avoidable rehospitalizations cost Medicare billions of dollars annually and lead to poor resident outcomes. Early discharge planning in SNFs for short-term stay rehabilitation has decreased rates of avoidable rehospitalizations, improved quality of life in geriatric residents, and improved care partners' perceived …

Implementing Bedside Shift Reporting On An Adult Medical-Surgical Unit: An Evidence-Based Intervention For Inpatient Fall Reduction, Halie Blackerby

Doctor of Nursing Practice Projects

Background: Patient falls are a continuous issue in healthcare facilities because they increase patient length of stay and hospitals receive no reimbursement for these falls from insurance providers. Falls are a patient safety issue and can result in long-lasting damage for patients in the healthcare facility, including fear of ambulation. Falls in a facility can impact a facility’s ability to meet strategic planning goals and receive state and federal funding.

Purpose: The Doctor of Nursing Practice (DNP) quality improvement project aimed to reduce inpatient falls during shift change by implementing an evidence-based bedside shift reporting (BSR) protocol.

Methods: Quantitative data …

A Quality Improvement Project: Improving The Clinical Practice For Assessing Hemoglobin A1c On Admission In Diabetic Ketoacidosis Patients Admitted To The Intensive Care Unit, Tiara Lawson

Doctor of Nursing Practice Projects

Background: Diabetic ketoacidosis (DKA) is a life-threatening problem that affects people with diabetes. Early treatment and adherence to guidelines are crucial in preventing DKA. The American Diabetes Association (ADA) publishes annual guidelines for effective DKA management, and the Education Recognition Program National Benchmarks program can help maintain adherence to the published guidelines. Improving the intensive care unit (ICU) admission process enhances the quality of care to DKA patients and improves progress towards national benchmarks.

Purpose: This quality improvement project aimed to improve Hemoglobin A1C (HbA1c) evaluations in DKA patients admitted to the ICU.

Methods: The intervention of triggering HbA1c orders …

A Quality Improvement Project To Reduce Facility-Acquired Pressure Injuries, Carolina Rosario

All Doctor of Nursing Practice (DNP) Scholarly Projects

Problem: Facility-acquired pressure injuries (FAPIs) pose significant risks to patient outcomes and healthcare costs ($500 to $70,000 per PI) in subacute rehabilitation (SAR) facilities. An assessment in a SAR identified a concerning pressure injury (PI) rate of 15.3%, exceeding the national benchmark of 10% for such facilities. This prompted an evidence-based quality improvement (QI) initiative.

Aim of the Project: This project aimed to reduce FAPI rates by 30% or greater among patients 65 and older using a PI prevention bundle called SSKINS (Skin, Surface, Keep moving, Incontinence/moisture, Nutrition/hydration, Self-management).

Review of the Evidence: A comprehensive literature review indicated that PIs …