Doctor of Nursing Practice - Scholarly Projects | 2021

Permanent URI for this collectionhttps://hdl.handle.net/11274/12982

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A1c Point of Care Testing with Type II Diabetes Patients to Increase Patient Engagement and Improve Glycemic Control
(2021) Mills, Kimberly
Background: Diabetes is at the forefront of chronic disease management. As the 7th leading cause of death in the United States, 34.2 million Americans are diagnosed with diabetes, and 95% have type 2 diabetes. Uncontrolled diabetes can result in long-term complications, increased hospitalizations, and premature deaths. Patient and provider partnerships are essential to increasing patient engagement to improve health care outcomes. Patient engagement, inclusive of collaboration with healthcare providers, promotes shared decision-making, enhancing patient self-care behaviors and effective disease self-management. Evidence supports that implementing point-of-care A1c testing (POCT HbA1c) in primary care settings promotes patient engagement with diabetes self-management resulting in improved patient glycemic control and attainment of organizational benchmarks for diabetic Value-Based Care quality metrics. Purpose: The purpose of this quality improvement project was for uncontrolled (HbA1c>8%) Type II diabetes patients to use POCT HbA1c to improve their glycemic control. Methods: Bandura’s Self-Efficacy Theory provided the theoretical framework. The RE-AIM model with PDSA cycles guided the project implementation. Data analysis consisted of descriptive and inferential analyses to track the implementation effectiveness of POCT HbA1c to improve glycemic control. Results: Data tracking demonstrated that implementation of POCT HbA1c increased diabetes patient self-management and improved glycemic control as evidenced by decreased HbA1c and FBS results. SES scores did not demonstrate statistical significance but there was clinical significance with increased patient engagement. Conclusions/Implications for Practice: The project outcomes supported that uncontrolled Type II diabetes patients who engage in the use of POCT HbA1c increase self-management resulting in improved glycemic control. Health care providers managing uncontrolled Type II diabetes patients should strongly consider using POCT HbA1c for diabetes patient self-management. Positive financial outcomes for both the patient and healthcare system can be a benefit with the use of POCT HbA1c. Project alignment with organizational initiatives is essential for obtaining support for implementation changes and long-term sustainability by conducting subsequent PDSA cycles.
Interdisciplinary Approach to Oral Care among Patients with Type 2 Diabetes: A Quality Improvement Project
(2021) Weaver, Rachel
The DNP project focused on the need to optimize the care provided to patients diagnosed with T2DM receiving care in a medical clinic in southeastern Texas. The project inquiry question: In adult (18-65 years of age) patients with the diagnosis of T2DM visiting the rural community supported indigent clinic, does standardized prophylactic dental treatment (SPDT) care (dental exam and cleaning and education) compared to no dental referral and education about dental care impact the HbA1c over a 2-year time period (2018-2019)? The quality improvement project analyzed the intervention of a dental clinic, providing prophylactic dental treatment to type 2 diabetic patients. A chart review of 411 patients identified 58 patients who met the criteria for the project. The purpose of this quality improvement project was to identify the impact of dental care on the patients with T2DM and their HbA1c levels. While the data was not statistically significant only showing p < 0.33 for the total HbA1c and p < 0.822 of the HbA1c between male and female, there was a clinical significance observed by a decrease in the HbA1c over the three time periods. The project does show the need for a standardized referral process for the patients with the diagnosis of diabetes to the dental clinic for annual exams and care.
Managing patients with diabetes distress: A quality improvement project
(2021-07) Thomas, Swapna; Smith, Melanie; Littles, Sabrenda; Tietze, Marie
The burdensome chronic disease of diabetes mellitus causes a significant emotional impact called “diabetes distress” leading to poor outcomes in patients. The importance of identifying and managing diabetes distress is currently being increasingly recognized, and guidelines from agencies like the American Diabetes Association (ADA) recommend routine screening for diabetes distress using valid screening tools. Interventions to address the issue are also recommended, one of them being Cognitive Behavioral Therapy (CBT) which was found to be beneficial in managing diabetes distress in several studies. The current project was designed to reduce diabetes distress and to improve outcomes in Type 2 Diabetes Mellitus (T2DM) using the framework of the health promotion model. The goal was to augment the comprehensive care of T2DM patients by the addition of the Problem Areas in Diabetes-5 (PAID-5) screening tool for diabetes distress, referral for and participation in CBT, and follow-up. The project employed multidisciplinary collaboration to deliver the intervention, and the feedback from the two-week follow-up call and the analysis of outcomes data indicated that the screening and intervention were beneficial. There was a significant reduction in diabetes distress and improvement in glycemic control in the patients. This project added to the knowledge base about the feasibility of screening and intervention in diabetes distress.
Implementation of Sleep Apnea Screening: A Practice Improvement Project
(2021) Mathew, Kanmony; Dunlap, Jayne Jennings; Tietze, Mari
"Patients and healthcare professionals often neglect sleep apnea symptoms. The clinical team identified the need for Obstructive Sleep Apnea (OSA) screening in the local cardiology clinic patients. Outpatient clinics provide an opportunity to engage patients in maintaining healthy lifestyles, promoting health and well-being. OSA risk increases in patients with heart disease worsening symptoms of coronary artery disease, potentially leading to myocardial infarctions and strokes. This practice improvement project included implementation of OSA screening, risk education counseling, and referral of high-risk patients for a home or in lab sleep study. Upon confirmation of OSA diagnosis, patients were referred to a pulmonologist for OSA treatment initiation. A quantitative analysis of the practice improvement initiative was used to establish its effectiveness, and SPSS version 26 was used to analyze the data. The project has the potential for greater impact and plans for sustainability are in place to provide ongoing screening and evaluation of outcomes. Keywords: sleep apnea, screening, diagnosis, home sleep apnea test."
Informed Perceptions of Knowledge, Attitude, and Behavior Concerning Nurse-Led Mobility Among Hospitalized Patients: An Evidence-Based Practice Project
(2021) Hudson, Tasha; Hawkins, Shelley; Bailey, Catherine; Roussel, Linda
Extended periods of bedrest among hospitalized patients are associated with functional decline and reduced mobilities. Data from a community based acute care hospital indicated there was a need to promote nurse-led mobilities, such as getting out of bed, ambulating about the room, sitting in a chair, and performing active or passive range of motion exercises among their patients. Lewin’s Force Field theory of unfreezing, moving, and refreezing provided the conceptual guidance to an evidence-based practice project which investigated the effectiveness of introducing a poster-style presentation to unfreeze the barriers associated with the anticipated changes in care. The Iowa Model-Revised and the Knowledge-To-Action framework provided methodologies to collaboratively plan and implement the project. The Johns Hopkins Patient Mobilization Attitudes and Beliefs Survey was administered in a pre-posttest design to assess initial and outcome perceptions regarding the barriers and facilitators to mobility promotion and their potential impact on the sustainability of any proposed practice changes. The pre-survey responses allowed the project team to ascertain the education programming needs necessary to inform nursing staff’s knowledge, attitudes, and behavior barriers to overcome. As a result of those initial survey responses, the team presented a poster-style presentation of strategies to inform the nursing staff's knowledge, attitudes, and behavior during the poster-style presentation. After completing the poster-style presentation, findings from the evaluation revealed that the staff had improved overall perceptions of mobility promotion barriers, with improvements in knowledge, attitudes, and behaviors.
From Taboo to Accepted: Increasing Gun Safety Counseling in Pediatric Primary Care
(2021) MacFarlane-Okongo, Shauna; Roussel, Linda
Firearm injuries are a leading cause of death among the pediatric population. Previous studies have shown that gun safety at home, meaning that firearms are locked up, unloaded, with ammunition locked up in a separate location, can help to reduce pediatric firearm injuries. Effective interventions, such as pediatric primary care health care providers (HCPs) doing firearm injury prevention (FIP) counseling while giving anticipatory guidance during a well child check, can have a strong impact on decreasing the number of firearm injuries. The evidence-based practice project used an existing evidence-based bundle approach to educate and train HCPs from primary care clinics within a large pediatric healthcare organization to consistently offer FIP counseling during as many well child checks (WCC) as possible. A pre-intervention survey distributed to HCPs was used for baseline measurements, with a bundled educational intervention and post-intervention survey 4 weeks later to assess for anticipated increased confidence, self-efficacy, and frequency in providing FIP counseling. Based on the findings of the project, recommendations were made for ongoing FIP training for HCPs.
Program Evaluation of a Fellowship for Advanced Practice Providers
(2021) Durand, Julie; Hawkins, Shelley
Introduction:
Increasing providers’ screening, diagnosing, and monitoring of metabolic syndrome in psychiatric patients: A quality improvement project
(2021) Olayiwole, Bolanie; Hawkins, Shelley; Roussel, Linda
Metabolic syndrome is a significant health issue and the use of antipsychotics increases its risk. However, monitoring metabolic syndrome in patients using antipsychotics is irregular. This quality improvement project aimed to increase evidence-based screening, diagnosis, and monitoring of metabolic syndrome in patients prescribed antipsychotic medications while ensuring providers are satisfied with the criteria provided for metabolic syndrome screening. The introduction of three evidence-based strategies helped to achieve the project’s aims that included (a) introduction of the NCEP-ATP III screening tool, (b) use of a metabolic monitoring form, and (c) educational or training sessions for the providers. Patient-based metabolic monitoring data were collected and analyzed using descriptive analysis of project variables and a run chart based on statistical control methodology. Analysis of the provider-based project data used descriptive analysis of the survey items, including each survey item's count. The project outcomes showed an increase in the assessment and accurate diagnosis of metabolic syndrome in patients using antipsychotics.

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