Addressing Stroke Care Disparities Through Patient Education, Christina Annerino

Honors Capstones

It has been found across current studies and evaluations of stroke care and patient outcomes that there is a disparity in disability and mortality between male and female patients who have experienced stroke. The aforementioned studies did not identify the cause of this disparity, although a number of hypotheses for this phenomenon were provided. This study then conducted a preliminary survey of 130 participants, both men and women, aged 18-80 years old, to evaluate potential barriers to accessing stroke care and receiving treatment effectively. Preliminary survey data demonstrated consistent gaps in knowledge related to stroke risks, stroke symptoms, and when …

Implementing An Insomnia Assessment And Management Algorithm In A Rural Pirmary Care Clinic, Rebekah Gaffin

Doctor of Nursing Practice Projects

Insomnia is the most common sleep complaint and significantly impacts quality of life and productivity. The accumulated total of direct and indirect healthcare costs related to insomnia is estimated to be as high as $100 billion/year and is associated with an increased risk of cardiovascular and cerebrovascular disease. Primary care providers play a critical role in identifying and implementing early interventions to address insomnia. However, this can be time-consuming, and providers may be unaware of the latest treatment guidelines and available resources. This project provided a research-based algorithm to identify and initiate treatment for patients 18+ with chronic insomnia in …

Using Readiness To Change For Dietary Modification In A Rural Primary Care Setting, Rebecca Johnson Beller

Theses & Dissertations

Cardiovascular disease is a prevalent noncommunicable disease. Modifying lifestyle behavior can decrease cardiovascular disease morbidity and mortality outcomes. This dissertation's purpose was to explore behavioral change interventions with dietary strategies to reduce cardiovascular disease rates. The integrative review explored aspects of dietary strategies in the primary care setting. Despite the importance of diverse studies, comparing all the components results in limited generalizability. In the following chapter, a cross-sectional study elicited healthcare professionals’ perceptions of the usefulness of a readiness for lifestyle change tool in clinical practice. Currently, a common, widespread adoption of a readiness for lifestyle change tool is not …

Addressing Air Quality Mitigation As A Key Factor In Asthma Management And Prevention, Julia Buckles, Jewel Radford

Doctor of Nursing Practice Projects

Asthma is the most prevalent disease in childhood and disproportionately affects African American (AA) populations in terms of prevalence and frequency of exacerbations. Air quality and environmental factors are strongly associated with the diagnosis and management of asthma and AA children are more likely to live in areas with poor air quality. An air quality flag program was implemented in a daycare located in a county with a predominantly AA population with a high prevalence of asthma diagnoses. The goal of the intervention was to increase staff awareness of air quality and the impact it can have on asthma diagnosis …

Implementation Of A Validated Suicide Screening Tool In A University Student Health Center, Tessa Welniak, Bailey Coslor, Cathrin Carithers

Doctor of Nursing Practice Projects: College of Nursing

Purpose. Suicide is the second leading cause of death among adults in the United States and Nebraska. Death by suicide impacts millions of adults every year in the United States but warning signs are often missed during visits with primary care providers. The University of Nebraska at Kearney (UNK) Student Health Center (SHC), like many other primary care clinics, did not routinely screen patients for suicide risk. According to the Joint Commission, all patients over 12 years of age should be screened for suicide using a validated screening tool if the visit is for any behavioral health concern. The project’s …

Increasing Human Papillomavirus Vaccine Uptake In Primary Care Using The 4 Pillars Program: A Quality Improvement Project, Hannah Lyons

The Eleanor Mann School of Nursing DNP Capstone Projects

Aim: To explore the effectiveness of the 4 Pillars Program on increasing human papillomavirus vaccination use in patients ages 9-18 years.

Design: A retrospective quasi-experimental research design comparing pre- and post-implementation human papillomavirus vaccination rates.

Keywords: human papillomavirus, vaccination, pillars, program, communication, tool, quasi-experimental, retrospective

Methods: A retrospective chart review identified the rate of encounters per provider where the human papillomavirus vaccine was administered to patients ages 9-18 years. Interventions including increasing access to the vaccine, standardizing provider recommendation of the vaccine, enhancing utilization of the electronic health record, and introducing a vaccine champion, known as …

Addressing Social Determinants Of Health In Medication-Assisted Treatment Programs, Audrey Hunter

The Eleanor Mann School of Nursing DNP Capstone Projects

Introduction: Medication-assisted treatment (MAT) is considered the most effective treatment for patients with opioid use disorder (OUD); however, MAT program retention rates are consistently low across the United States. Addressing social determinants of health (SDOH) through text message could impact MAT retention; therefore, a pilot project at a federally qualified healthcare center (FQHC) was implemented.

Methods: The Protocol for Responding to and Assessing Patients’ Assets, Risk, and Experiences (PRAPARE) SDOH screening tool was implemented for patients undergoing MAT for OUD. Community resource referrals were provided via text message based on the screening results. Retention in treatment was measured by prescriptions …

The Impact Of Authoritative Parenting Compared To Authoritarian And Permissive Styles On Long-Term Psychological And Behavioral Function Of Offspring., Brooke Washington

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Different parenting styles produce specific traits in offspring that are of direct relation to the chosen parenting style of the household. The goal of this study is to answer the question: What is the impact of authoritative parenting compared to authoritarian and permissive styles on long term psychological and behavioral function of offspring? This systematic review was conducted to collect and analyze studies relating to the long-term psychological and behavioral effects of offspring who were raised in one of the three most common parenting styles practiced: authoritative, authoritarian, and permissive. The authoritative parenting style is classified as establishing a warm, …

Effects Of Group Visits On Self-Care Management For Veterans With Type 2 Diabetes Mellitus, James Nwaizugbu

Doctoral Projects

Individuals diagnosed with type two diabetes mellitus (DM2) can be overwhelmed by daily choices, leading to self-care neglect. Self-care is vital to DM2 management to avoid chronic complications. This project utilized group visits to increase self-care management and improve outcomes among veterans with poorly controlled DM2.

This evidence-based practice (EBP) project used a single-group quasi-experimental pretest-posttest design to evaluate a self-care management program for US veterans with poorly controlled DM2 who were enrolled a clinic within the Department of Veterans Affairs (VA), Northern California Healthcare System (NCHCS). The study facilitator provided education on DM2, medication, diet, and exercise. Participants (N …

Utilization Of The Reproductive Justice Framework In Contraceptive Counseling With Black And African American Women: A Comparison Of Patient Satisfaction And Provider Knowledge, Simranjeet K. Tagore

Doctoral Projects

Current practice in contraceptive counseling is characterized by great variation in both content and implementation. The literature indicates that African American women desire contraceptive counseling based in respect, trust, and equity. Conducted over 8 weeks, this quality improvement project compared satisfaction in African American and Black patients receiving contraceptive counseling by a provider trained in the Reproductive Justice Framework (RJF) versus those receiving contraceptive counseling by a provider not trained in the Reproductive Justice Framework. This project also evaluated the effects of Reproductive Justice Framework training on clinician knowledge. Inclusion criteria for the patients included identifying as Black and/or African …

Primary Care Access In San Luis Obispo County- Primary Care Practitioner’S Perspectives, Jessica Peckham

Doctoral Projects

This study investigates healthcare access and utilization among Primary Care Providers (PCPs) in SLO County, utilizing a mixed-methods approach. Survey responses from PCPs when applied to Levesque’s Theoretical Framework reveal variations in provider approachability and acceptability, alongside significant wait times for both new and established patients, indicating barriers in healthcare reaching. Qualitative interviews further illuminated dimensions of healthcare access, including socioeconomic disparities and provider burnout. These underscore the complexities of ensuring equitable access to primary care services. The relationship between provider and consumer dimensions, such as work-life balance, workload, and the role of advanced practice providers, highlight the intricate dynamics …

Evaluation Of An Emergency Department Provider Information Update On The Initiation Of Suboxone With A Community Treatment Program Referral For Opioid Overdose And Opioid Use Disorder, Carmen Brewington

All Dissertations

Over 21 million people in the United States (U.S.) require substance use disorder (SUD) treatment; yet less than 4 million people receive treatment (Bressan & Kening, 2023). According to Thomas et al. (2022), opioid overdose deaths are increasing, and improving access to evidence-based treatment is critical. Hospital emergency departments (EDs) play a lifesaving in the emergency treatment of opioid overdoses; but can also serve as gateways to opioid treatment by healthcare providers for opioid addictions (Reuter et al., 2022). Mortality, after an ED visit for opioid overdose, is high (Thomas et al., 2022). Community resources are limited, thus making it …

Pneumococcal And Influenza Vaccine Co-Administration In The Incarcerated Population, Kaitlyn Stroh

Doctor of Nursing Practice Projects

Background/Significance: Streptococcus pneumoniae is responsible for 20-60% of U.S. bacterial pneumonia cases and has a mortality rate of 10-30%. Invasive pneumococcal disease (IPD) occurs when streptococcus pneumoniae invades otherwise sterile sites. Adherence to immunization guidelines is 60-70% effective at preventing IPD. Co-administration of pneumococcal and influenza vaccines has shown promise at increasing uptake of the pneumococcal vaccine and enhancing immunological response. Population/Setting: A state-run Department of Corrections (DOC) clinic system serving just over 30,000 individuals was the site for this project. Incarcerated individuals present an increased risk of contracting pneumococcal disease due to close living quarters. Other risk factors such …

The Lived Experience Of Nurses In Caring For Patients With Covid-19, Jessica Barre

Electronic Theses and Dissertations

Limited research exists about the experiences of nurses’ caring for patients during the COVID-19 pandemic post hoc. To understand nurses’ realities of caring for patients with COVID-19, I aimed to understand the lived experience of nurses caring for patients with COVID-19 in the United States. A qualitative design with a hermeneutic phenomenological methodology was used. Sixteen participants were recruited via purposive sampling, augmented with snowball sampling. Data were collected through unstructured interviews and were analyzed using Braun and Clarke’s Reflexive Thematic Analysis. Nurses’ experiences of caring for patients with COVID-19 in the U.S. were consolidated into four themes: “a living …

A Multimodal Intervention To Aid In Smoking Cessation, Lauren Druzbicki

Evidence-Based Practice Project Reports

The Centers for Disease Control and Prevention (CDC; 2023a) notes there are 28.3 million smokers in the United States. In Indiana alone, nearly 29% of adults currently use tobacco, with 19% of the total being cigarette smokers (Indiana Department of Health, 2022). The purpose of this evidence-based practice (EBP) project was to implement a multi-modal intervention to aid in smoking cessation in adults aged 18 and older who are cigarette smokers. The intervention included physician/nurse advise using the ask, advise, refer (AAR) model, the SmokefreeTXT program, and FDA approved smoking cessation medications. The project took place at a primary care …

"Salir Adelante": Improving The Quality Of School Entrance Physicals For Immigrant Minors, Jennifer Sternberg, Elizabeth Morse

DNP Projects

The purpose of this QI project was to improve the delivery of school physicals in the setting of an -friendly non-profit safety-net clinic by creating a patient-centered clinical pathway to improve focused screening and referrals for newly arrived migrant children and their families by routinely assessing and addressing behavioral health care (BH) and social determinants of health needs (SDoH).

Using QI methodology and Donabedian’s Structure Process Outcomes framework, the project team implemented a clinical pathway that included an immigration-focused history of present illness, systematic behavioral health (BH), and social determinants of health (SDoH) screenings embedded within an electronic health record …

Referral To In-Person Smoking Cessation Counseling As A Smoking Cessation Aid, Annie Mandrell Bsn, Rn, Matthew Keathley Bsn, Rn, Lewis Linden Bsn, Rn, Laura Reed Dnp, Aprn, Fnp-Bc, Cne

Doctor of Nursing Practice Projects

Referral to In-Person Smoking Cessation Counseling as a Smoking Cessation Aid

Purpose/Background

Smoking increases an individual’s risk of acute and chronic disease morbidity and mortality, as well as creating a financial burden for the individual and healthcare system. In the United States, tobacco smoking is the leading cause of preventable death. There are an estimated 5 million tobacco-related deaths each year due to tobacco smoking. Additional healthcare costs are also seen due to the need for increased treatments, medical supplies, and staffing. Previous research for smoking cessation resources has primarily focused on traditional primary care offices. Research shows that in-person …

Implementing Universal Adult Depression Screening In A Rural Maine Free Medical Clinic, Karen Hussion

Doctor of Nursing Practice Scholarly Projects

Abstract

BACKGROUND: Depression in adults is a leading cause of disability, morbidity and mortality worldwide with an estimated prevalence of 20% in the US population. Despite estimates that one out of every five Americans suffers from depression, less than 50% of adult primary care patients with depression are identified, and less than 5% of all adult primary care patients are screened. To increase early detection and management of depression, the United States Protective Service Task Force (USPSTF) recommends routine depression screening for adults older than 18 years in primary care settings.

LOCAL PROBLEM: This project site was a rural, free, …

Cultural Education Interventions Impact On Cultural Competence, Kaylie V. Griffin Ms

ONU Student Research Colloquium

Problem: In the United States, there is a substantial increase in diversity. This increase in diversity poses multiple challenges for healthcare workers and healthcare systems. Because nurses care for patients with various cultural backgrounds, health beliefs and practices, and languages, cultural competency plays a pivotal role in providing patient-centered care. There is a need to enhance cultural education for healthcare workers to ensure that healthcare workers have the skills and knowledge to effectively engage with all patient populations. Implementing cultural education interventions seeks to increase healthcare workers' competency, communication, and patient outcomes. Purpose: The purpose of this research question is …

Evidenced-Based Strategies To Increase Cervical Cancer Screening Rates, Tuong Cat Vo Bsn-Rn, Nada Salloukh Bsn-Rn, Tatiana Elena Swanson Bsn-Rn, Xiao Mie Cindy Zhu Bsn-Rn, Laura Taylor Reed Dnp, Aprn, Fnp-Bc

Doctor of Nursing Practice Projects

Purpose/Background

Cervical cancer is the fourth leading cause of cancer affecting women worldwide (Staley et al., 2021). With cervical cancer being a preventable disease, an effective method of reducing healthcare costs and mortality is primary prevention, such as screenings. Financial burdens and barriers to accessing medical care may result due to the lack of proper cervical cancer screenings. Detecting cervical cancer includes screening women 21 to 65 years old with a Papanicolaou (PAP) test every three years. Women aged 30 to 65 years old can extend the screening of cervical cancer by having a Human Papillomavirus (HPV) test along with …