Family Practice Nursing Commons^™

Incorporating Home Visits In A Primary Care Residency Clinic: The Patient And Physician Experience, Mary Caitlin St. Clair, Jessica J. F. Kram, Glenda Sundberg

Journal of Patient-Centered Research and Reviews

Purpose: Home visits, once a popular but now uncommon form of health care delivery, are on the rise. Few studies have focused on the value the experience brings to resident physicians and their patients.

Methods: A 6-month pilot was conducted with 11 residents who participated in 32 home visits with 11 patients. Patient and resident experiences were captured through a survey following the home visits.

Results: In all, 100% of patients and a majority of residents were very interested in being a part of and incorporating future home visits, respectively. Every patient in the survey said that the visits resulted …

Implementation Of An Evidence-Based, Electronic Clinical Algorithm To Improve Screening, Evaluation, And Referral Of College Students For Depressive Symptoms And An Evaluation Of Differences Based On Sexual Orientation And Gender Identity Data, Chris Webb

Graduate Theses, Dissertations, and Capstones

The purpose of this project was to improve the screening, evaluation, and referral of college students (LGBTQ+/Heterosexual) for depressive symptoms through the implementation of an evidence-based, electronic clinical algorithm. There is evidence in the literature indicating that there are increased mental health disparities among college students and the LGBTQ+ population. The prevalence of depressive symptoms among university students is higher than the general population, requiring university student health centers to implement enhanced screenings for depressive symptoms and identification of depression predictors. Prior to implementation of this project, a student health clinic in the Southeastern part of the United States used …

House Calls Are Reaching The Tipping Point — Now We Need The Workforce, Thomas Cornwell

Journal of Patient-Centered Research and Reviews

Home-based primary care (HBPC) improves the lives of high-cost, frail, homebound patients and their caregivers while reducing costs by keeping patients at home and reducing the use of hospitals and nursing homes. Several forces are behind the resurgence of HBPC, including the rapidly aging population, advancements in portable medical technology, evidence showing the value of HBPC, and improved payments for HBPC. There are 2 million to 4 million patients who could benefit from HBPC, but only 12% are receiving it. The number of these patients is expected to double over the next two decades. This requires a larger and better …

Human Papillomavirus (Hpv) And Cervical Cancer, Stephanie Gregorc

Nursing Student Class Projects (Formerly MSN)

Human papillomavirus (HPV) is one of the most common sexually transmitted diseases with more than 100 types. The American Cancer Society (2019) reports, “Most men and women who have ever had sexual contact will get HPV at some time in their lives.” Certain strands are more detrimental than others, however it is important to understand how it spreads and ways to minimize its occurrence. Preventative actions are available to women, such as pap smear screenings, which can allow for early identification and treatment of abnormalities. As an advanced practicing nurse, it is essential to provide education to women surrounding HPV, …

Male Breast Cancer, Angie Blose

Nursing Student Class Projects (Formerly MSN)

Male breast cancer (MBC) is a disease that claims the lives of many unsuspecting men. MBC affects less than 1% of men only one out of a thousand will be diagnosed with the disease. According to the American Cancer Society (2019) this year, 2,670 men will be diagnosed with breast cancer (MBC) and at least 500 of them will loose their lives to this disease. Most breast cancers in males are diagnosed as ductal carcinomas (Chalasani, 2019). This poster provides insight about risk factors, diagnosis, testing, staging, and signs and symptoms of this disease.

Polycystic Ovarian Syndrome, Erin Branfield

Nursing Student Class Projects (Formerly MSN)

Abstract

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in females of reproductive age, affecting up to twenty percent of females (McEwen & Hartmann, 2018). Though the pathophysiology of PCOS is not fully understood, several factors such as insulin resistance and increased testosterone levels are prevalent and play a major role in PCOS. PCOS is a complex disease and encompasses many different metabolic, endocrine and reproductive conditions. Common signs and symptoms of PCOS include but are not limited to menstrual cycle disturbances, acne, alopecia and fertility problems (Balen, 2017).

Keywords: PCOS, Polycystic ovarian syndrome, insulin resistance

Nephrolithiasis, Erin Layton

Nursing Student Class Projects (Formerly MSN)

Nephrolithiasis, also known as kidney stones and calculi, pose a significant health and financial burden in the United States and worldwide. With the increasing incidence and prevalence of pediatric and adult nephrolithiasis, health care costs and morbidity are expected to rise (Batavia & Tasian, 2016). Once thought to be an isolated condition, nephrolithiasis is now considered to be a systemic disease and a marker for other systemic diseases like cardiovascular disease and hypertension. Furthermore, there is a correlation between nephrolithiasis and obesity, fractures, and chronic kidney disease (Ziemba & Matlaga, 2017). In the case of obstruction of an infected kidney, …

Multiple Sclerosis Pathophysiology, Carolyn Ricketts

Nursing Student Class Projects (Formerly MSN)

Abstract

Multiple Sclerosis (MS) is a chronic autoimmune disease characterized by inflammation in the central nervous system and demyelination of the white matter in the brain and spinal cord, leading to lesions and axonal damage, possibly followed by relapse. It is a progressively debilitating disease with a variety of symptoms that mimic other diseases, such as blurred vision, nerve pain, fatigue, weakness, paresthesia, and unsteady gait. It occurs more frequently further from the equator. The pathophysiology of MS is unknown. Several new research theories are emerging which include innate and adaptive immunity playing a role (TH1 and TH17 specifically), infection …

A Rural Telehealth Objective Structured Clinical Examination, Devon Schlottach

Dissertations

Problem Rural healthcare consumers experience increased health disparities, especially when accessing health care. The use of telehealth to improve access has become an essential competency for nurse practitioner (NP) students. This study evaluated NP students’ confidence and competence of rural social determinants of health (rSDOH) before and after a telehealth simulation.

Methods A descriptive, cohort design was used to review NP students’ pre- and post-surveys, written case studies, and a video-recorded telehealth OSCE for a patient living in a rural area.

Results Student self-rated knowledge of rural health care did not improve despite didactic learning and simulation (z = …

Depression In Hiv-Positive Individuals Living In A Residential Housing Community, Danielle Njeri

Dissertations

Problem: Depression is the most prevalent psychiatric disorder among individuals living with HIV. Depression rates are three times greater than those found in the general population . Undiagnosed and untreated depression can have a negative effect on the management of HIV infection, resulting in increased mortality and a poorer quality of life. The purpose of this quality improvement initiative was to assess the incidence of depression in HIV-positive individuals living in a residential community.

Methods: A prospective, descriptive, cohort design. Convenience sample of HIV-positive adult residents living in an HIV residential community. The nine-question patient health questionnaire (PHQ-9) …

Just Culture: It's More Than Policy, Linda Ann Paradiso, Nancy Sweeney

Publications and Research

Any healthcare organization’s top priority is effective and safe care. Despite this, medical error is the third-leading cause of death in the US. Hospitals are imperfect systems where nurses have competing demands and are forced to improvise and develop workarounds. Errors rarely occur in a vacuum, rather they’re a sequence of events with multiple opportunities for correction. Clinical nurses can have a significant impact on reducing errors due to their proximity to patients. When errors are identified, the events and impact on safe care need to be shared. Just culture is a safe haven that supports reporting. In a just …

Utilization Of Evidence-Based Telehealth For Routine Follow-Up Visits In Outpatient Palliative Care, Kori Fitzgerald Bsn, Rn, Phn, Fnp/Dnp Student

Doctor of Nursing Practice Final Manuscripts

Title: Utilization of Telehealth for Palliative Care Follow-up Visits

Background: A vital part of cancer management is the implementation and integration of palliative care, to prevent and relieve suffering and to improve quality of life for patients with serious chronic illness. However, access to palliative care services continues to be inadequate. There is a nationwide shortage of skilled palliative providers and the supply is insufficient to meet the growing demand.

Purpose of Project: Implementing telehealth visits with palliative care patients with advanced cancer at the UCSD Moores Cancer Center has the potential to maintain patient satisfaction with …

Reducing Ed Re-Admissions In Post-Op Neuro Patients Utilizing A Np Telephone Follow-Up Protocol, Katherine Curran

Doctor of Nursing Practice Final Manuscripts

Reducing ED Re-admissions in Post-Op Neuro Patients utilizing a NP Telephone Follow-up Protocol

Background

Post craniotomy patients discharging from the hospital to home, commonly present to the emergency department (ED) with incisional concerns. Complaints stem from minimal post-op education, poor incision management, and lack of knowledge relational to infection. Unanswered questions prior to discharge lead to unnecessary ED visits, anxious calls after discharge, and poor patient satisfaction. ED admissions lead to fortuitous costs that can be prevented through evidenced based interventions.

Purpose/Aim

Post craniotomy patients at a large hospital system in Southern California will have decreased ED visits correlated to …

Spreading The News About Peanuts: Implementing An Infant Allergy Risk Assessment, Kelly E. Kotula

Doctor of Nursing Practice Final Manuscripts

Peanut allergies are the leading cause of death from food anaphylaxis. In 2017, the National Association of Allergy and Infectious Disease (NIAID) issued a guideline for use by primary care providers to identify infants who would benefit from early peanut consumption. Many providers have not yet implemented these guidelines in clinical practice. The purpose of this project was to implement a practice change to improve assessment of risk factors for peanut allergies utilizing the NIAID guideline in infants at their six-month well-child examination at a pediatric primary care practice. Risk factors assessed included: a history of eczema and/or egg allergy …

Standardizing Mammogram Screening In Primary Care: Integrating An Evidence Based Approach, Lacrisha Go

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Mammogram screening for surveillance and detection of breast cancer has long been recognized as a preventative health measure for women. However, easily recognizing when to screen individual women, based on age and risk factors, lacks clear guidance and often ends in fragmented and inconsistent practices among providers.

Methods: By developing and implementing the Screening Mammogram Initiation Protocol (SMIP), the desired goals of this project were to: a) align breast cancer screening recommendations to better meet individualized patient needs in primary care utilizing best practice guidelines, b) increase the rate of breast cancer screening across various demographics, and c) …

Are Students’ Being Distracted Drivers, Jill Buchholz, Ronda Christman

Adventist Human-Subject Researchers Association

The life of a nursing student can be very fast paced. Trying to keep up with friends and family while studying can be a challenge. Learn how frequently students are driving distracted, are on social media, and have personal devotions.

Childhood Obesity: Getting Back To The Basics, Fanny Powell

DNP Qualifying Manuscripts

Childhood obesity is an epidemic that affects the nation. The Centers for Disease Control and Prevention (CDC) (2015) states that over the past thirty years, the prevalence of childhood obesity has more than doubled in younger children and quadrupled in adolescents (CDC, 2015). Although obesity is a multifactorial health issue that is affected by genetics, metabolic factors, socioeconomic factors, and lifestyle choices (Stanford, 2018), a majority of pediatric obesity is as a result of consuming more energy than the body utilizes. There are both immediate and long-term consequences of obesity that negatively affect a child’s health which may carry over …

The Implementation Of A Behavioral Intervention Program In Obese Elderly Patients, Zandra Brown

Doctor of Nursing Practice Projects

Abstract

The prevalence of obesity is increasing in American and patients are living longer. Research suggests that behavioral lifestyle interventions help optimize elderly patient’s health and improve their quality of life. A successful behavioral weight loss program had been in place in one clinic within a large healthcare organization. The need at another metropolitan Midwest location seemed even greater due to having a patient population consisting of elderly, demographics, obesity trends, and high rates of obesity linked morbidities such a diabetes, hypertension, and heart disease. Thirteen elderly obese patients with ages ranging from 65-75 years old were enrolled in an …

Using An Electronic Health Record Alert System To Screen And Manage Patients With Diabetes Mellitus Type 2 In A Rural Primary Care Setting, Simon Katumu

Doctor of Nursing Practice Projects

Diabetes Mellitus type 2 is the 7th leading cause of death and affects nearly 10% of the US population. Early detection of this condition leads to the initiation of treatment and lowers the risk for complications and better outcomes. Frequent testing of hemoglobin A1Cs in those already diagnosed also leads to better management, glycemic control and improves health outcomes. This project utilized a feature in the electronic health record system of a rural primary care clinic to remind providers to screen at-risk patients and retest those who were either due or overdue for hemoglobin A1C testing. Hemoglobin A1C readings were …

Provider Awareness Associated With Lifestyle Interventions And Adult Obesity, Reilly Tackett

Doctor of Nursing Practice Scholarly Project

The obesity epidemic cannot be solved through a single solution. A complex problem like obesity requires an intricately designed approach, comprised of both behavioral and environmental changes (Centers for Disease Control, 2015). Obese adults who attempt to alter their lifestyles often experience barriers to success. One such barrier is a provider who may be unfamiliar with evidence-based lifestyle interventions. Research suggests large variances both in provider knowledge levels and practice recommendations associated with adult obesity. This study’s purpose was; to determine if provider recommendations reflected clinical practice guidelines (CPG) associated with adult obesity, to measure current levels of provider knowledge, …