Doctor of Nursing Practice - Scholarly Projects | 2019

Permanent URI for this collectionhttps://hdl.handle.net/11274/11117

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Parental awareness of childhood obesity: A quality improvement initiative
(2019) Cole, Leticia; Roussel, Linda
The incidence of childhood obesity continues to rise, placing an increased risk of morbidity and mortality in adulthood. Over the years, the perceived “normal” weight increased causing a shift in parental misperceptions of their child’s actual weight (Hansen, Duncan, Tarasenko, Yan, & Zhang, 2014). Parental misperception of their child’s weight status is likely to lead to decreased motivation to address and change childhood obesity (Lundahl, Kidwell, & Nelson, 2014). Examination of parental perceptions can generate instructive information for addressing parental perceptions, increasing readiness to change, and managing the overweight and obese child. (Hansen et al., 2014). The goal of this quality improvement project was to assess parental perceptions of the overweight child and readiness to change behaviors. The project analysis revealed there remains a disproportionate number of parents who underestimate their child’s weight, as well as an association between parental perception of their child’s weight and readiness to change. This misperception is one that must be addressed to begin the process of treating and managing obesity. The results are intended to provide information to assist in increasing awareness of parents’ perceptions of their overweight child’s weight status as a starting point to the next steps towards implementing an obesity prevention and management plan.
Text message appointment reminders to improve clinic attendance: A general internal medicine (GIM) clinic quality improvement (QI) project
(2019) Valdres, Rosalie; Roussel, Linda
The lack-of-attendance rate at outpatient clinics is an inherent problem for the global health system, the United States healthcare system, and the local healthcare system. We aimed to decrease the no-show rate by implementing a quality improvement (QI) project at the community General Internal Medicine (GIM) Clinic. This QI pilot project focused on the use of text message appointment reminders that were bundled with telephone reminders along with patient-reviews of the no-show policy. The Plan-Do-Study-Act (PDSA) process was used in implementing the system. The pre-intervention no-show rate was 27%. During the intervention, the no-show rate decreased to 22% the first week, 5% the second week, and 8% the third week. The number of patients who did not attend their clinic appointments decreased while the clinic’s reimbursement rate increased. The QI team expanded the use of the text message reminder system to all of the providers in the clinic. The QI pilot project improved the clinic attendance of the GIM Clinic. Consequently, the GIM Clinic staff adopted the QI project model. The model supports consistent care for healthy patients as well as those who are critically and chronically ill. Also, the adoption of the model will help to improve the clinic’s income.
The effect of simulation on the self-confidence of newly licensed graduate nurses
(2019) Mante, Rosario; Smith, Melanie
Newly licensed graduate nurses (NLGNs) enter practice with basic critical thinking skills and minimal experience. However, they are often placed in clinical areas based on the needs of the facility rather than their clinical interest or expertise. New graduate nurses are assigned roles that are not based on their levels of proficiency but the needs of the facility. The transition from nursing student to independent practice causes stress as they apply their learning to real-world practice. They experience reality shock when exposed to the complexity of patient care, heavy workloads, technological advances, and lack of communication skills. All these factors contribute to role dissatisfaction and nurse turnover. Nurse turnover is costly and negatively impacts hospital budgets, staff, and patient outcomes. Ninety-one percent (91%) of NLGNs feel stressed by their jobs. Within 1–2 years, 33% leave their first nursing job. In January 2018, Nursing Solutions Incorporated (NSI) published the results of their study that showed 28.3% of all new registered nurse (RN) hires left within a year and 49.8% exited after less than two years of service. New graduate nurses benefit from additional training through continuing education and simulation during their first year as licensed graduate nurses. Additional training helps to minimize the transition gap between student and independent practice (Dyess and Sherman, 2009). New graduate nurses who successfully transition reduce the rate of nurse turnover, thereby helping healthcare organizations show a positive return on investment to (Silvestre et al., 2017). This project study explored NLGNs’ perceptions of their simulation experiences and determined that there is no sufficient evidence that simulation has an impact on enhancing self-confidence. However, there is evidence that simulation has an impact on the overall anxiety level when making clinical decisions. The results of this study demonstrate the value of using simulation as a supplement to traditional standard clinical experiences and identify ways to enhance NLGNs’ self-confidence and decrease anxiety when making clinical decisions. The data may assist nursing educators in creating educational programs that improve NLGNs’ self- confidence in practice as registered nurses.
Fall reduction program among elderly residents in skilled nursing facility
(2019) Jacob, Latha
Falls are the leading cause of fatal and non- fatal injuries among the elderlies. Falls threaten seniors’ safety and independence & generate enormous economic and personal costs (NCOA, 2018). The specific aim of the project is to provide an intervention that would reduce incidence of falls among elderly residents in a skilled rehab facility. The QI study will consist of analyzing the application of intervention which mainly includes forming a Fall prevention team, fall risk assessment tool, fall leaves signs, yellow skid socks for high-risk patients, hourly rounding and post fall huddle. The researcher will collect data from EHR of the number of falls before and after interventions and analyzed. Since falls are a leading cause of injuries in skilled rehab facility, addressing this issue is a priority as it has so many consequences. As staff knowledge and implementation of fall prevention interventions increase, patient fall rate will correspondingly decrease.
Identifying effective PHQ-9 cut-off points for depression in adolescents
(2019) Wheat, Janet; Kubin, Laura
PURPOSE: The purpose of this evidence-based practice project was to identify an optimal PHQ-9 Depression screening tool cut-off point in identifying depression in the adolescent population in a primary care setting. METHODS: A plan-do-study-act model was utilized for the implementation of this project. A retrospective chart review was conducted including statistical analysis and interpretation of the PHQ-9 cut-off points in a primary care practice. A matched pairs t-test was used to analyze the practice-wide use of the PHQ-9 Depression Screening tool in the adolescent population. RESULTS: Archival data for 90 adolescents was collected. The mean age of participants was 14.97 years. Participants were predominantly Caucasian and female. Thirty-seven (41.1%) of the adolescents were diagnosed with depression based on a mean score of 12.57 on the PHQ-9. Adolescents meeting the criteria for depression had statistically significant higher PHQ-9 scores than those having no diagnosis of depression. The average or mean score for adolescents diagnosed with depression using the PHQ-9 screening tool was 12.57, however, the analysis demonstrated that a score as low as 7.5 could indicate depression. Therefore, a score of > 7.5 was determined to be the optimal cutoff point for maximizing sensitivity of the PHQ-9 without loss of specificity. CONCLUSIONS: The volume of adolescents seen in the primary care setting affords a rich opportunity in identifying depression in the adolescent population. Current evaluation suggests that using the validated PHQ-9 depression-screening tool with cut-off points of 7.50 or greater would be more effective in the current primary care setting, allowing for purposeful interventions to improve screening for depression in the adolescent population and their outcomes.
Identifying preeclampsia through patient education: A quality improvement initiative
(2019) Silas, Kyanna; Menendez-Bobseine, Margarita
Preeclampsia is a major problem in the United States that increased risk of neonatal and maternal morbidity and mortality. Will educating patient and support persons that accompany patients to clinic visits increase awareness of early signs and symptoms of preeclampsia? This quality improvement initiative will consist of a pretest on preeclampsia, followed by an educational sheet on preeclampsia, and then a posttest to confirm successful education. This confirmation should result in a sample size of 80 with an 80% power to detect a mean of paired differences of 0.2 with an estimated standard deviation of differences of 0.6 and with a significance level of 0.05 using a two-sided paired t-test. Validation of success is measured by an increase of 20% on the posttest. The findings will suggest that educating patients and support persons should result in seeking early medical attention when signs and symptoms of preeclampsia arise.
Warfarin for venous thromboembolism prophylaxis in lung transplant recipients: A quality improvement project
(2019) Wu, Chunxia
Lung transplant recipients have a high risk of developing venous thromboembolism (VTE) and increased mortality from VTE due to lack of bronchial circulation after transplant. Increased risk of VTE is also observed in patients taking sirolimus as part of their immunosuppression regimen. Currently, there is no guideline on long-term VTE prophylaxis in this patient population. A protocol was developed at a single lung transplant center where 1 mg warfarin was used in lung transplant recipients who take sirolimus to reduce the risk of VTE. This project was a retrospective chart review study to compare the VTE rate in patients who were treated with 1mg warfarin and those who were not. The study found a VTE rate of 27.2 % in lung transplant recipients taking sirolimus at this transplant center. There was no reduction in VTE with the use of 1mg warfarin. Male gender was found to be an independent risk factor for VTE development. Hospitalization, surgery, and central line placement were found to be associated with significant increased risk for VTE. Limitations of the study include retrospective design, selection and recall bias, confounding bias, and small sample size. More aggressive measures are warranted to prevent VTE in patients with multiple risk factors. The results from the study can be used to guide further research and practice in this perspective.
Comparison of GLP-1 and SGLT2 diabetes medication: A quality improvement initiative
(2019) Dilliard, Julia; Chrostowski, Susan
This quality improvement research project was undertaken to compare the efficacy of glucagon-like peptide agonist (GLP-1) and sodium-glucose cotransporter-2 inhibitor (SGLT2) medications in the treatment of Type II Diabetes Mellitus. Literature review reveals that both these new medications have shown efficacy in lower A1c and weight in Type II diabetics but have not been studied in a head to head trial. The objective of this project was to determine if one of these medications provides more HgA1c lowering than the other. This information is be useful for practitioners when choosing the most appropriate treatment. This project was a retrospective chart review of 128 charts divided evenly between patients who had been prescribed GLP-1 medication or SGLT2 medications between the years 2013 and 2018. A1c was measured when the medication was initiated and then measured at three-month and six-month intervals for data comparison. Repeated measures of ANOVA were conducted and showed that both medications provided A1c and weight loss at 3-months that were similar (p=.000). At 6 months the GLP-1 medication group showed a more substantial drop in A1c levels than the SGLT2 medication group and was statistically significant (p=0.046). This project revealed that a GLP-1 medication lowered A1c more than SGLT2 medications at the end of 6 months. These findings indicate GLP-1 medication may be more efficacious than SGLT2 medication in achieving glycemic control for Type II diabetic patients.
Epilepsy knowledge profile and epilepsy self-management: A quality improvement study
(2019) Kamau, Catherine; Haley, Sheila M.
BACKGROUND AND PURPOSE: Epilepsy is a chronic neurological disorder marked by recurrent seizures. It affects approximately 60 million people worldwide and is the most prevalent chronic neurological condition globally. This quality improvement study was conducted to evaluate whether there was a correlation between general epilepsy knowledge and epilepsy self-management practices in adult patients with epilepsy. METHOD: A descriptive cross-sectional survey was conducted between January 2019 to February 2019 in a metropolitan adult neurology clinic. Two standardized questionnaires, the Epilepsy Knowledge Profile- general (EKP-Q) and the Adult Epilepsy Self-Management Measurement Instrument (AESSMI), were emailed using a PsychData link to patients diagnosed with epilepsy. RESULTS: A total of 39 participants responded to the survey. Four only filled out the demographics part and did not complete the questionnaires. Thirty-five completed both questionnaires but only 29 had valid data on the AESSMI part of the questionnaires. A simple bivariate analysis was completed using the variable EKP-Q and AESSMI. A weak positive correlation between epilepsy knowledge and epilepsy self-management was found with a Pearson correlation coefficient (r=0.378). The level of correlation significance was established at a p-value of 0.05. DISCUSSION: The hypothesis for this study expected a strong positive correlation between epilepsy knowledge and epilepsy self-management. The results found a weak positive correlation due to limitations of time and missing data. Recommendations for future studies is for data to be collected over more extended periods with incentives given to participants for completing the surveys. It is also recommended that future patient education programs focus on both aspects of knowledge and self-management for improved patient outcomes in epilepsy.
A family-based intervention targeting childhood obesity among Ghanaian immigrants: Quality improvement project
(2019) Asomani, Gladys; Abraham, Annie
Childhood obesity is an epidemic in developed and undeveloped countries. Obesity and being overweight are said to have a significant effect on physical health, as well as social and psychological consequences in children. The effects of environmental factors, lifestyle behavior, and cultural beliefs play a significant role in this epidemic. Most parents do not identify their children as obese or overweight due to their lack of understanding of childhood obesity. Obesity in the Ghanaian culture is viewed as a positive implication in life; therefore, the quality improvement (QI) project is centered on providing knowledge to influence change regarding obesity. This QI project of a family-based intervention targeting childhood obesity among Ghanaian immigrants using a diet and physical activity approach will help bring awareness and knowledge change. The specific target population for this project was Ghanaian mothers who reside in the United States, who are between the ages of 21 and 43 years, and who have children in a faith-based location. The instrument used in this project was the Family Eating and Activity Habits Questionnaire (FEAHQ), which is categorized into four phenomena, including activity level, eating style, eating related to hunger, and stimulus exposure. Concerning activity levels, the M scores were 1.51 for mothers, 1.28 for fathers, and 2.08 for children. The eating style category was higher at posttest for mothers, at t (22) = 10.04, p =.000. In the eating related to hunger category, 80% of children will delay eating when not hungry compared to a pretest response of 32%. The M score for families eating in restaurants decreased from 1.80 pretest to 1.04 posttest.
Barbershop blood pressure program: A quality improvement project
(2019) Kirkpatrick, Whitney; Oquin, Charli Lois
Black males suffer from hypertension at far greater rates than any other demographic group. Such disproportions are due to complex, multifaceted factors ranging from perceived discrimination, physician bias, lack of culturally fluent healthcare providers, and an overall distrust of medicine marred by racist medical experimentation. Targeted healthcare delivery models have been shown to results in better outcomes when compared to current, traditional models. This project capitalized on the pre-existing trust between black barbers and their black male clients. Barbers administered blood pressure screenings at time of grooming services. This intervention brought the healthcare directly to the patient in a familiar place of comfort. Over 45 days, barbers conducted blood pressure checks on a combined 456 clients. Analysis of the blood pressure checks was performed with the Mann-Whitney U test and the Chi-Square test. Variables included systolic pressure, diastolic pressure, age, previous referral for hypertension, and medications. The findings did not suggest a statistically significant difference in blood pressures amongst those screened after being notified of their elevated pressure. However, the study shed light on the problem, fostered dialogue, and prompted black men to see a healthcare provider.
Early recognition of postpartum depression through education: A quality improvement initiative
(2019) Ekeocha, LaSteshia; Oquin, Charli Lois
Many women have misplaced high expectations after giving birth to care for themselves, the newborn, the home, and breastfeeding with little to no sleep. As a result, they may feel inadequate in their role and ashamed to ask for assistance and suffer from postpartum depression (PPD). Although the mother may not be willing to admit these feelings and concerns, if properly educated, her support systems may recognize early signs of PPD and encourage her to seek medical attention. Studies have shown that the support system of the woman plays a crucial role in the prevention, diagnosis and effective treatment of PPD. This quality improvement (QI) initiative utilized the existing literature to formulate an educational pamphlet geared towards the support system. The initiative was implemented over four weeks in a women’s health clinic. A sample size of 183 participants partook in a pre and post-test in order to measure the knowledge gained. Categorical variables were evaluated using the Chi-square test between the pre and post questions. Continuous variables were evaluated using t-test between the percentage of pre and post proportion correct. The findings of the study suggest that support system education increases PPD awareness and knowledge.
A quality improvement initiative: Motivations and barriers to hospital nursing employee participation in workplace wellness program
(2019) Bagh, Rose; Oquin, Charli Lois
Purpose: The purpose of this evidence-based quality improvement (QI) study was to identify the characteristics that are associated with participation in hospital-based workplace wellness programs among hospital nursing employees. The goal was to identify the perceived motivations for and barriers to participation in hospital-based workplace wellness programs faced by hospital nursing employees such that it may provide a basis for increased participation by hospital employees in workplace wellness programs in the future.
Advanced practice provider initiated advance care planning discussions to enhance patient-centered end-of-life care
(2019) Goswami, Poonam
Advance Care Planning (ACP) is the process by which patients, with their healthcare provider and family establish values, goals, and preferences for future care, and include discussions on End of Life (EOL) care options. Advance Directives (AD) provide written documentation of patient’s wishes for future care and comprise of a Medical Power of attorney, living will document, and an Out-of-Hospital Do Not Resuscitate (OOHDNR) order. Institute of Medicine (IOM) in their 2014 report, Dying in America, identified an urgent need for improvement in health care at the end of life. The IOM also called for patient-centered EOL care that honors individual preferences and promotes quality of life. Cancer patients experience the high cost of care, may also receive unwanted treatment towards the EOL, and additional suffering, which may not reflect their values and goals. The problem exists that only 20% of the patients have completed AD documents in the Department of Investigational Cancer Therapeutics (ICT), and admitted patients’ resuscitation status remains a full code, which includes a cardiopulmonary resuscitation, and endotracheal intubation with mechanical ventilation. This Doctoral of Nursing Practice project consists of designing, implementing, and evaluating the effect of ACP discussions initiated by an Advanced Practice Provider with advanced cancer patients and their family members in the ICT department. The project aims to enhance patient-centered EOL care with a goal to increase the AD completion and /or a change in code status of the patients referred to ICT department.
Faith-based culturally-tailored diabetes prevention program for African Americans
(2019) Manning, Carol; Roussel, Linda
Background: The prevalence of prediabetes and type 2 diabetes mellitus (T2DM) in the United States (U.S.) continue to increase. African Americans (AAs) are disproportionately affected by T2DM, thus delivery of diabetes prevention programs (DPP) in a church setting is an effective way to disseminate health information and/or encouraging AAs to adopt healthy lifestyles. Purpose: The purpose of this study was to evaluate the effectiveness of an 8-week culturally-tailored DPP in mitigating the risks for the development of T2DM (also called “diabetes”) in a sample of AA church members through the implementation of the “Power to Prevent” DPP. The DPP was scripturally based and delivered in a church setting. The Diabetes Risk Test (DRT) was used to screen for eligible participants, with a score of five or greater indicating one’s risk for the development of T2DM. Methods: Baseline, and 8-week outcomes measures assessed: (a) knowledge of diabetes prevention strategies, (b) nutrition knowledge, (c) physical activity level, (d) body mass index (BMI) and, (d) weight loss of 5% to 7% of baseline bodyweight. Findings: Seventeen participants (56.6%) completed the study. The mean DRT score was 5.52. Knowledge of diabetes prevention strategies (p = 0.040), and healthy nutrition (p = 0.000) were significant. Physical activity (p = 0.188), and BMI (p = 0.109) did not improve significantly. Mean percentage weight reduction was 1.69%. Conclusion: Ongoing implementation of DPPs which target AAs in real-world settings such as their places of worship are needed to stem the tide of the diabetes epidemic in the U.S.
Increasing awareness of sexually transmitted infection through education: A quality improvement initiative
(2019) Thompson, Dennia; Roussel, Linda
Each year it is estimated that millions of people are affected by sexually transmitted infections (STIs). Sexually transmitted infections are transmitted through sexual contact with an infected person through vaginal, anal, or oral sex. Untreated STIs can have a negative impact on a woman’s reproductive organs and can cause long-term health consequences. Effective interventions such as education to increase awareness of sexually transmitted infection can have a positive effect on decreasing the spread of these infections. The quality improvement (QI) initiative used existing evidence-based literature to educate the women who tested positive for an STI. The initiative was implemented over a 4-week timeframe in a women’s clinic (WC). A sample size of 100 women, 18 years and over, participated in the initiative. The data analysis for the standardized, evidence-based education demonstrated an increase in awareness among the women who participated in the initiative. The findings of the study reinforce the use of evidencebased education on STIs as a way to raise awareness.

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