Encouraging Human Papillomavirus Vaccine Uptake: A Healthcare Improvement Project, Lauren E. Woll

Dissertations

Abstract

Problem: Human papillomaviruses are the causative agents of >95% of cervical cancers, most oropharyngeal and anogenital cancers, yet the vaccination status of the population remains critically low despite Gardasil9 offering robust protection against HPV-related disease.

Methods: This quality improvement project utilized a descriptive, observational design to assess the effect of the HPV Encouragement Bundle, a two-step intervention to improve HPV vaccine uptake. Quantitative data was collected via retrospective chart review to assess the effect of the intervention on first-dose administration of Gardasil9 (series initiation), as well as overall Gardasil9 vaccine uptake.

Results: Following implementation, Gardasil9 first dose uptake increased …

Implementing Obesity Management Guidelines In Rural Primary Care, Taylor Bell

Dissertations

Abstract

Problem: In the United States, obesity is one of the leading causes of death among Americans and rates of obesity continue to rise. Geographic location significantly affects the number of obesity cases, with rural areas being affected more than other locations. Despite this, obesity continues to be undertreated by rural primary care providers.

Method: This quality improvement (QI) pilot project utilized a descriptive, observational design to evaluate the implementation of an evidence-based clinical practice guideline algorithm for obesity management in a rural primary care clinic. An algorithm was implemented on patients aged 18-60 years and with a BMI of …

Improving Postoperative Breast Augmentation Patient Education Delivery., Madison Callery

Doctor of Nursing Practice Papers

Background: Effective patient education promotes successful postoperative outcomes. Nurses in an outpatient surgery center lacked consistent patient education practices and materials.

Purpose: The purpose of the project was to implement an evidence-based multimodal educational strategy for patients who undergo breast implant surgeries.

Methods: At an outpatient plastic surgery center, pre- and post-intervention phone calls were tracked; post-intervention education, documentation, and patient satisfaction data were recorded. Nurses were educated on the new materials, delivery procedures, and electronic health record (EHR) documentation. All patients undergoing breast implant surgery received multimodal education at each postoperative appointment. Outcomes included (1) the number of patient …

Physical Exercise As A Lifestyle Modification To Lower Blood Pressure In Hypertensive Females With A Body Mass Index Greater Than 25, Kacee Pee

Doctor of Nursing Practice Projects

Background: Hypertension affects many Americans nationwide and, if untreated, can cause heart attack, stroke, and chronic kidney disease. Hypertension (HTN) accounts for about 1 in 5 deaths of U.S. women and is a greater burden for women than men (Wenger et al., 2018). Women who are overweight increase their risk of developing hypertension. Lifestyle modifications, such as diet and exercise, are the first-line treatment for hypertension. Physical exercise is a crucial component of lifestyle therapy for the primary prevention and treatment of hypertension. Several studies consistently demonstrate the beneficial effects of exercise on hypertension, with reductions in both systolic and …

Using Physical Therapy As First Line Treatment For Sciatica Vs. Invasive Intervention, Christina Mohammed

Master of Science in Nursing Family Nurse Practitioner

Sciatica nerve pain affects a large part of the human population. Evaluation by a primary care provider and a referral to physical therapy as first line treatment, may help reduce sciatic nerve pain and result in reduced need for invasive surgical intervention.

Improving Patient Self-Efficacy, Readiness, And Completion Of Advance Care Planning Documents Using Prepare Documents And Advance Care Planning Group Referral, Marie Vassiliadis

Doctor of Nursing Practice Final Manuscripts

Advance Care Planning (ACP) is an ongoing discussion about medical decision making between a provider, patient, and support person. ACP can also include legal documentation in the form of an advance directive (AD). Nationally, only 36.7% of adults complete any form of AD for end-of-life care. Recently, ACP has become an important quality metric that many organizations are prioritizing. The purpose of this evidence-based project is to improve ACP readiness, self-efficacy, and documentation among patients at an internal medicine clinic using the PREPARE program and referral to an ACP group meeting. PREPARE for Your Care is an online program aimed …

Implementation Of An Evidenced Based Peripheral Artery Disease Screening Protocol In An Outpatient Internal Medicine Clinic, Sarah Lee Bolanos

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidenced based project was to implement an evidenced based peripheral artery disease screening protocol in an outpatient internal medicine clinic serving adult patients with multiple co-morbidities. This clinic inconsistently screened patients for PAD using the ankle-brachial index (ABI).

Methods: During a three-month period, 50 patients were screened using current American Heart Association and American College of Cardiology (AHA/ACC) screening guidelines for PAD using the Ankle-Brachial Index (ABI) and the Edinburgh Claudication Questionnaire (ECQ).

Results: Out of the 50 patients screened for PAD, only one patient (2%) had a normal ABI score (1.0-1.4) and was categorized …

Implementation Of The Generalized Anxiety Disorder 2-Item Screening Tool For Adult Patients In An Underserved Outpatient Cardiology Clinic, Leila Joint

Doctor of Nursing Practice Final Manuscripts

Background: 11.7% of adults aged 18 and over have regular feelings of worry, nervousness, or anxiety. Anxiety can often present with somatic symptoms. The rates of misdiagnoses are high with symptoms often attributed to physical etiologies. Early recognition and treatment of anxiety can improve quality of life, prevent complications and reduce health care costs.

Purpose of Project: Implementation of the Generalized Anxiety Disorder 2-item (GAD-2) screening tool in a fast-paced underserved outpatient cardiology clinic for adult patients presenting with chest pain and/or palpitations without documented history of anxiety. The purpose of this project is to improve the utilization …

Feasibility Of Family Focused Obesity Screening In Primary Care, Adrianne Griffiths

Doctor of Nursing Practice Final Manuscripts

Background: Obesity is associated with serious medical conditions including diabetes, hypertension, and heart disease. It also contributes to decreased productivity at work and school, financial strain, and reduced quality of life.

Purpose of Project: To address this problem, a nurse practitioner-led screening and intervention program was piloted at a primary care clinic in southern San Diego. The tool provides a standardized method for screening individuals and their families for nutrition and physical activity deficits associated with obesity, as well as appropriate and effective interventions to prevent and manage obesity.

Methods: The Family Nutrition and Physical Activity (FNPA) screening tool is …

Implementation Of The Diet Readiness Test To Assess Self-Efficacy And Education Effectiveness In Overweight Women, Tatjana Ilich

Doctor of Nursing Practice Final Manuscripts

Purpose: The purpose of this evidence-based Doctor of Nursing Practice (DNP) project was to assess perceived self-efficacy in overweight women who are participating in a weight loss program and the effectiveness of education being provided using the Diet Readiness Test (DRT).

Background: Obesity is a rapidly growing public health problem affecting an increasing number of countries worldwide because of its prevalence, costs, and health effects. Among women between the ages of 40 and 60, more than 80% report that they are either trying to lose weight or trying to maintain weight. The overall prevalence of obesity was similar among men …

Anxiety And Agitation In Adult Patients Admitted To An Emergency Room During The Covid-19 Pandemic, Doris L. Asombrado

Dissertations

Purpose: The purpose of this retrospective correlational study was to identify the relationship between COVID-19 status and the prevalence of anxiety-agitation with select sociodemographic and clinical characteristics in adults admitted to the ED during the pandemic (03/01/2020 through 12/31/2020).

Background: COVID-19 infections combined with the WHO and CDC recommendations to mitigate spread have had deleterious psychosocial and economic outcomes with the risk of subsequent COVID-19 related mental illness. Studies indicate one in three adults experience anxiety or depression.

Methods: This retrospective correlational study reviewed 2,572 psychiatric admissions from a Southern California ED during the pandemic from March 1, 2020 through …

Implementing Outpatient Screening Of Adult Patients At High Risk For Peripheral Artery Disease, Coral Roseberry

Doctor of Nursing Practice Final Manuscripts

Background: Peripheral artery disease (PAD) is a prevalent chronic vascular disease that remains often underdiagnosed and inadequately treated. The development of PAD increases both with age and with the presence of modifiable and non-modifiable risk factors. Risk factors for PAD include smoking, diabetes, hypertension, hyperlipidemia, and chronic kidney disease. Furthermore, PAD can be an indicator of systemic atherosclerosis which is associated with coronary artery disease, carotid stenosis, and cerebrovascular disease. Undiagnosed obstructive PAD contributes to damaging atherosclerotic sequelae such as claudication, ulcers, infections, peripheral neuropathy, and amputations. It is common for PAD to exist in the absence of symptoms; therefore, …

Assuring A Continuum Of Care For Heart Failure Patients Through Post-Acute Care Collaboration, Purnima Krishna

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Heart failure (HF) patients have a high risk of rehospitalization after discharge from acute care. Post-discharge management of HF patients requires coordinating services outside the hospital, such as skilled nursing and home health care to address patients’ complex needs.

Local Problem. High HF readmission rates negatively impact a hospital’s efficiency and pose a risk of financial penalties. In the project setting, the HF patients discharged to skilled nursing facilities and home health agencies had a higher rate of 30-day readmission than patients discharged to home.

Methods: Fourteen post-acute care (PAC) facilities were selected for the interventions. The …

Reducing 30-Day Heart Failure Hospital Readmissions Through The Implementation Of A Telehealth Education And Screening Program, Madison Geib, Jo Loomis, Maria (Dupi) Gomez Cogan

Doctor of Nursing Practice (DNP) Projects

Heart Failure (HF) is a difficult disease to manage. It requires knowledge on weight monitoring, diet, exercise, medications, and symptom management. With this difficulty, there is a high incidence of HF patient readmissions into the hospital, especially in the first 30-days after discharge, showing that patients are not well equipped to manage their HF on their own at home. A review of the available literature found that some of the most common reasons for readmission include poor discharge planning, a lack of continuation of care, as well as a lack of education and adherence to their medications (Mathew & Thukha, …

A Lifestyle Modification Intervention In Hispanic Adolescents With Nonalcoholic Fatty Liver Disease, Brianne Miller

Evidence-Based Practice Project Reports

U.S. population studies have confirmed that the Hispanic population has the highest prevalence and the worst prognosis for non-alcoholic fatty liver disease (NAFLD) (Katz et al., 2021). The purpose of this evidence-based practice project was to implement a multicomponent, lifestyle modification intervention in Hispanic pediatric primary care patients to combat the disease process and sequela of NAFLD. The PICOT question for this project was: In Hispanic adolescents aged 10-21 with obesity and NAFLD (P), what is the effect of a multicomponent, lifestyle modification intervention (I), on alanine aminotransferase (ALT) (O), over a 12-week time period (T)? A comprehensive literature search …

The Impact Of Personal Barriers To Incorporating The American Heart Association Diet, Aaron Bigando

Doctor of Nursing Practice Scholarly Project

The leading cause of death worldwide is cardiovascular disease. Diet is the most influential, modifiable factor related to the development and progression of cardiovascular disease. The American Heart Association developed a diet that delivers guidelines for diet. Therefore, identifying the most significant factors that hinder the effectiveness of the diet was necessary. These hindrances can be categorized as physical, psychosocial, and socioeconomic barriers. Demographic differences also impact diet.

A survey was developed to identify and account for the most common dietary barriers. The Barriers to Healthy Eating scale addressed different circumstances which impact diet. By using this scale, providers can …

Fantastic Four, Jaden Zumbahlen, Andrea Palmer

Doctor of Nursing Practice Projects

Clinical Issue
Heart failure claims one in four lives of those diagnosed each year. The term Guideline Directed Medication Therapy (GDMT) represents optimal medication therapy as defined by the American College of Cardiology Foundation and American Heart Association. Appropriate quadruple therapy results in an estimated 73% relative reduction in mortality over a two-year time span (Greene & Khan, 2021). However, there is a gap in proper GDMT stemming from suboptimal initiation and/or titration in the outpatient setting.

Project Implementation
Nursing staff in a rural midwestern cardiology clinic were provided with an in-service presentation discussing current guidelines and recommendations of GDMT …

Use Of Anticipatory Guidelines In Late Infants And Toddlers 12 To 24 Months In Primary Care, Claire E. Eller

Doctor of Nursing Practice Projects

Anticipatory guidance is a well-known and utilized method that has been implemented in a majority of pediatric primary care offices. As the need for efficiency grows and increasing patient volumes climb, there is a growing need for strategies to provide this information effectively and efficiently. Prior evidence can be utilized to identify the most critical knowledge caregivers and parents will require. Our findings indicate safety, communication, nutrition, social development, and behavior as cornerstone topics for anticipatory guidance. To increase the volume of education provided to parents and caregivers, alternate methods beyond verbal discussion could be used. After gathering scientific literature …

Caring For The Adult Patient With Autism: Development Of Staff Education And An Online Toolkit For Healthcare Providers, Kristen Conkle

Doctor of Nursing Practice Projects

There are disparities in knowledge among healthcare workers when caring for adult patients with autism spectrum disorder (ASD). Lack of knowledge about the characteristics of this population and strategies to enhance care pose a barrier to treatment during hospitalization. A computer based educational module was developed and assigned to staff at a community hospital. An online toolkit for healthcare providers was developed to aid staff in recognition of triggers and supplied adjunct methods for communication. A pre and posttest of healthcare provider knowledge and stigma regarding autism was performed. Achievement of the training was robust among staff; of the one …

Sti Education For Adolescents, Maryann Van Ryn, Lucy Nyrongo

Doctor of Nursing Practice Projects

Adolescents make up the majority of STI cases in the United States; however, most STI education has not targeted them and their unique needs. This quality improvement project aimed to create an evidence-based educational tool for sexually transmitted diseases (STIs) for adolescents in a pediatric clinic. Next, we created a dynamic QR code to access the flyer digitally on a patient's mobile device. The QR code was printed and placed in an accessible location in the office. The dynamic QR code allowed us to capture data on the total number of scans and provided the demographics of the scanners and …