Implementation of a Caregiver Education Tool in the Hospice Setting

Freburger, Sarah Elizabeth ProQuest Dissertations & Theses Salisbury Universi 2020 해외박사(DDOD)

Problem Statement: Available research shows that most caregivers of hospice patients do not feel confident or prepared to care for their loved ones in the home. Although evidence shows that providing thorough education can contribute to improving caregiver confidence, the Hospice of the Chesapeake (HOC) does not utilize a standardized method for providing education to caregivers.Purpose: The purpose of this DNP project was to determine if the use of a standardized educational tool, called the CARES Tool, would increase the confidence of family caregivers who were caring for hospice patients within a community-based hospice organization.Methods: A quality improvement project was implemented with a one-group pretest- posttest design. Thirty participants were obtained from a convenience sample of primary caregivers of patients newly admitted to the Hospice of the Chesapeake. Baseline caregiver confidence scores were collected from participants utilizing the modified Caregiver Confidence in the Sign/Symptom Management (CCSM) Scale. The caregivers then took part in an individual, nurse led, educational session using the CARES Tool. After the intervention, caregiver confidence scores were collected again.Results: There was a significant difference in the caregiver confidence scores before (M = 3.173, Variance = 0.952) and after (M = 4.445, Variance = 0.187) the educational intervention; t (29) = -6.977, p < 0.05. Significance: This quality improvement project was successful in demonstrating that the use of a one-on-one educational session utilizing the CARES Tool was effective for improving the confidence of family caregivers caring for patients of the Hospice of the Chesapeake.

Implementation of a Bystander Intervention Model to Promote Referrals to and Enhance Utilization of Mental Health Resources by Students in a Community College Setting

Leeds, Lindsey Wright ProQuest Dissertations & Theses Salisbury Universi 2022 해외박사(DDOD)

The coronavirus (COVID-19) pandemic increased college students’ risk and prevalence of mental health conditions. However, campus mental health resources have been underutilized, and referral of students in need hindered by bystanders' (i.e., faculty, staff, peers) lack of preparedness. This Doctor of Nursing Practice (DNP) project aimed to improve bystanders’ preparedness using evidence-based practice (EBP). Expected outcomes included increased referrals to and utilization of mental health resources and improved access to care for college students. Guided by Social Cognitive Theory and Bystander Effect Theory, the project also focused on the concepts of self-efficacy and confidence. Workshops, based on the BeVocal bystander intervention model, were provided virtually to volunteers from a suburban, community college’s faculty/staff and student populations. Participants completed anonymous surveys for demographic data and Gatekeeper Behavior Surveys for self-rated confidence, preparedness, and likelihood to act pre- and post-workshop. A postcard was developed and provided for participants as a resource post training. Significant improvement was found post-workshop in participants’ preparedness (p < 0.001), self-efficacy (p < 0.001), and likelihood to intervene (p = 0.002) for both sample groups. A 115.09% increase in concerning behavior reports and an 87.54% increase in referrals to college mental health resources occurred during the four months after the workshop implementation. Access to mental health care forcollege students was promoted through community engagement and increased preparedness to recognize and refer. Based upon the results, the BeVocal bystander intervention model and workshops will be continued at the community college through a grant obtained for the program.

Implementation of a Diabetes Education Initiative in a Privately-Owned Family Practice

Ward, Howard William, III ProQuest Dissertations & Theses Salisbury Universi 2022 해외박사(DDOD)

Of the 34 million Americans living with diabetes mellitus (DM), approximately 95% have type-2 diabetes mellitus (T2DM), which is characterized by insulin resistance and gradual loss of insulin production (Centers for Disease Control and Prevention [CDC], 2019). Inefficient use of insulin causes excess glucose to build up in the bloodstream placing individuals at high risk for target organ damage (CDC, 2019). In rural and underserved areas of the country, the prevalence of T2DM among Americans continues to grow at an alarming rate (CDC, 2019). This office-based quality improvement project utilized a pre-test post-test design to assess patient self-care knowledge of T2DM before and after a standardized education session. The purpose of the education was to reinforce patient understanding of DM, as well as promote healthy lifestyle modifications to effectively manage the disease in patients residing in a rural, underserved area. This project aimed to answer the following question: “In adults 18 years of age and over recently diagnosed with T2DM, does early implementation of standardized disease-specific education increase patient Revised Diabetes Knowledge Test (RDKT) scores and compliance with T2DM management over standard care?” Participants were recruited from a privately-owned family practice located in a rural, underserved area, and those patients with a recent or new diagnosis of T2DM were eligible to participate. Descriptive and inferential statistics were used for quantitative data analysis. A one-samplet-test showed statistical significance in the difference in pre-test and post-test scores before and after the education, t (4.922), p < .05. Findings from this DNP project have potential to contribute to the lack of data and improve clinical practice in other rural, underserved areas.

Use of a Standardized Telehealth Visit Tool to Improve Care Outcomes of Veterans in Home-Based Primary Care (HBPC)

Talley, Chrystal Chan ProQuest Dissertations & Theses Salisbury Universi 2022 해외박사(DDOD)

In the United States, approximately two million homebound, older adults have chronic health conditions and disabilities. Providing primary care to this high-risk population is challenging and requires evidence-based strategies to address higher treatment noncompliance, lower medication adherence, decreased continuum of care, higher risk for hospitalizations, and disproportionately high healthcare costs. This project implemented evidence-based practice (EBP) of a standardized telehealth visit tool to increase access to primary care for homebound veterans. Anticipated outcomes included an increase in telehealth visits, holistic documentation, and a decrease in emergency room (ER) visits post-implementation. A synthesis of literature highlighted best practices during telehealth visits to include utilization of a standardized tool. A telehealth visit tool was developed to guide visits conducted by nurse case managers and other providers in a home-based primary care (HBPC). During a three-month period, telehealth visits were offered to all veterans enrolled in the HBPC program located in the Northeast region in the United States. Data including demographics, number of telehealth visits, tool usage, and number of ER visits and hospitalizations with diagnosis were analyzed pre- and postimplementation.Telehealth visits improved access to care for homebound veterans with a 373.3% increase in the total number. The standardized tool assisted nurse case managers and providers to maximize the benefits of and promote continuity of primary care using telehealth. Hospitalizations and ER visits did not decrease, perhaps due to the short implementation period, an increase in COVID-19 cases, and the high-risk population’s multiple comorbidities.

Design and Implementation of an Evidence-Based Solid Organ Transplant Patient Education Protocol

Rothstein, Amy ProQuest Dissertations & Theses Salisbury Universi 2022 해외박사(DDOD)

Kidney transplant recipients require comprehensive education about medications and caring for their new organ before discharge to prevent unwanted complications, including hospital readmission. Literature supports the need for comprehensive education to enhance outcomes. The purpose of this Doctor of Nursing Practice (D.N.P.) quality improvement project was to design, implement, and evaluate the impact of an evidence-based patient education protocol for kidney transplant recipients that focused on patient medication knowledge, nurse medication knowledge, patient satisfaction, and readmission rates at a transplant intermediate care (IMC) unit. Pender’s Health Promotion Model (HPM) guided the conceptual underpinnings, and the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model was used to organize the project. Evidence from a systematic review of literature was utilized to develop a standardized education protocol. Descriptive statistics were used to assess patient knowledge of medications and patient readmission rates pre- and post-implementation. Qualitative data analysis was performed to evaluate nursing knowledge surrounding patient education prior to implementation and their confidence in their delivery of education post-implementation. Analysis of patient 30-day readmission rates demonstrated a downward trend postimplementation. In addition, patients displayed satisfactory knowledge about their medications with an average score of 83.33% nurses who were more engaged during education sessions, and 75% of nurses felt more confident in their educational abilities. Results of this D.N.P. project supported how implementation of evidence-based patient education protocols can enhance and improve the process of medication education for both transplant patients and nursing staff to improve outcomes.

Promoting Use of Continuous Glucose Monitoring Devices at a Pediatric Clinic through Online Education and Peer Support

Mbah, Glenise ProQuest Dissertations & Theses Salisbury Universi 2022 해외박사(DDOD)

Type One Diabetes Mellitus (T1DM) poses social and health threats to the lives of many individuals. In the past, management of diabetes mellitus has revolved around the use of Self-Monitoring Blood Glucose devices such as fingersticks. Today, advancement in diabetes technology has led to the innovation of Continuous Glucose Monitoring (CGM) devices, which has drastically influenced how diabetes is treated. The leaders of this DNP project hoped to bring awareness of CGM to young people with diabetes and provide resources that would assist them in making informed decisions about how to manage this illness. Because CGM use continues to be lowest among young people (Tanenbaum et al., 2018), an educational program titled the Level-Up Workshop was developed to improve how this population perceives and uses CGM devices. The Level-Up Workshop was a virtual educational workshop designed to provide education on CGM use to youth with T1DM receiving diabetes-related care from a pediatric clinic. Workshop activities were geared towards improving problem-solving, trouble-shooting, and social support. Two workshop sessions were implemented and during each session, participants engaged in a series of activities led by a diabetic educator, a CGM device representative, and young people with T1DM. Recruitment to the workshops was challenging, and a total of 4 young people were eventually enrolled. Both patients and staff participants were positive about the experience. Despite the low number of participants, the format of this project shows promise as a means of educating young people with diabetes.

The Influence of a Structured Educational Intervention on Nurse's Knowledge and Confidence in Teaching Patients about Genomic Testing

Rodriguez, Yvette ProQuest Dissertations & Theses Salisbury Universi 2022 해외박사(DDOD)

Nurses are essential healthcare team members who use knowledge of genomics to help shape a patient’s diagnosis and prognosis. A significant barrier to assuring that patients and families benefit from this rapidly emerging knowledge is the lack of recognition of the value of genomics on health outcomes across the health professions. Nurses must become proficient at interpreting genomics test results, delivering appropriate counseling and making referrals to the right specialists. The purpose of this project was to develop and implement an educational intervention about genomics and genomic testing for nurses and nurse practitioners to expand their knowledge in this area and promote increased confidence with patient education. Participants were asked to complete a pre and post-educational intervention survey to measure knowledge about genomics and genomic testing and level of confidence/comfort in educating patients about genomic testing. Data were collected on the number of genomic tests ordered three months prior to the educational intervention. Post- intervention, three months of data were assessed once again to look for an increase in the number of orders for genomic testing. Due to the small sample, planned inferential statistical analyses were not conducted. Overallfindings were mixed with some gains in knowledge of genomic testing, confidence, and comfort in discussion with patients and families and making referrals to the precision medicine clinic, but a decline in the number of genomic tests ordered.

Standardized Screening Tools for Substance Use in Primary Care

Sloan, Breanna ProQuest Dissertations & Theses Salisbury Universi 2020 해외박사(DDOD)

Problem Statement: Screening, brief intervention, referral and treatment [SBIRT], is an evidence-based practice with the potential to improve health outcomes but has yet to be routinely translated into primary care practice despite the available evidence and ongoing rise of substance use disorders. Screening is the first, crucial step to this process. The literature supports the use of universal screening in all health care settings. Several barriers exist to the implementation of universal screening into primary care such as time limitations, medical needs, lack of training, stigma, and role conflict. Purpose: Driven by the Health Promotion Model and FADE Model frameworks, the purpose of this quality improvement project was to increase use of screening tools for substance use in primary care. This project focused solely on the universal screening process. Methods: Education and training was offered to staff at an internal medicine office on a valid and reliable standardized screening tool (ASSIST), in order to increase use of the tool. A chart review was completed pre-implementation of the education sessions for current screening efforts. A second chart review was completed post-implementation to determine screening compliance utilizing the ASSIST. Data collection focused on data over a 30-day time period and logged in an audit form. Results: The number of patients screened for substance use increased after implementation of staff education and training. Significance: This study supported the use of the ASSIST tool to increase identification of patients with substance use in a primary care setting. Future recommendations include use of EHR for screening and incorporation of the entire SBIRT model.

Nurse-led Advanced Care Planning in Primary Care

Deem, Anastasiya ProQuest Dissertations & Theses Salisbury Universi 2020 해외박사(DDOD)

Problem Statement: Advance care planning (ACP) enables individuals to make decisions about medical treatments they want to receive when they are facing a medical crisis and cannot speak for themselves. Literature demonstrates that ACP discussions amongst individuals with chronic conditions lead to numerous benefits such as improved quality of life; however, ACP is rarely completed due to an array of barriers, including a lack of clinic-based support.Purpose: This DNP project aimed at improving nurses’ knowledge of ACP and advance directives (ADs), as well as their ability to initiate ACP/AD discussions with patients through implementation of nurse-led ACP discussions in primary care settings. The overreaching goal of this project was to increase the number of completed ADs for patients with chronic conditions.Methods: Three nurse care-coordinators received education focused on ACP/ADs prior to implementing nurse-led ACP in two primary care offices. Qualitative data analysis was performed to evaluate nurses’ knowledge of ACP/AD before and after receiving education. Descriptive statistics were used to assess AD completion by patients with a primary diagnosis of CHF, COPD, or DM during nurse-ledACP implementation period.Results: Nurses’ knowledge regarding ACP/ADs improved post ACP/AD educational session. Nurse care-coordinators identified 46 eligible patients without ADs, of which 67% participated in nurse-led ACP discussions, resulting in 20% of patients completing ADs.Significance: Nurse-led ACP has demonstrated potential to increase the number of patients with ADs. Future adoption of nurse-led ACP for all patients with chronic diagnoses may help standardize ACP discussions and improve AD completion rates in all settings.

Using a Bimodal Approach: Depression Screening and Physical Performance Testing to More Accurately Identify Depression in Community Dwelling Older Adults

Hargis, Christina Wallace ProQuest Dissertations & Theses Salisbury Universi 2020 해외박사(DDOD)

Problem Statement: The National Institute of Mental Health estimates that 17.3 million adults in the United States have experienced at least one major depressive episode. Thirty-five percent of all adults with major depressive disorder received no treatment. In Wicomico County (2014), 28 percent of residents experienced symptoms of chronic depression. The Maintaining Active Citizens (MAC) center in Salisbury provides a depression program, yet only eight participants from the three lower counties of the Eastern Shore utilize their services.Purpose: The purpose of this DNP project was to utilize a four-meter timed test to determine gait velocity in conjunction with the Patient Health Questionnaire 9 (PHQ-9) to more accurately identify depression in community dwelling older adults.Methods: In a convenience sample, participants in the Program to Encourage Active, Rewarding Lives (PEARLS) and mobile fall clinics completed a six-item cognitive screener, four-meter timed test to determine gait velocity and the PHQ-9 depression screening to assess depression.Results: A total of 24 participants met eligibility criteria over a three-month period (n=24). Using cross sectional methods, no correlation was discovered between gait velocity and depression scores. A negative correlation between the age of respondents and their depression score was noted. According to the Six-item Cognitive Screener higher cognitive deficits indicated overall lower depression scores. A relationship between living alone and lower depression scores was noted.Significance: This project was unable to replicate previous data showing correlation between slower gait velocity and increased depression scores. Ultimately, a change in practice occurred; the mobile fall clinic now includes this depression screening.