Nursing (Doctor of Nursing Practice)

A social-learning group was used to train caregivers of school-age augmentative and alternative communication (AAC) users. Training was aimed at the caregiver of emergent AAC users and occurred in the home and community settings using a modeling strategy. Instruction was primarily delivered in three 15-minute training sessions using Facebook. In addition to social media instruction, the caregiver-child teams met with other participants to practice and implement newly learned skills during community activities. Meetings were approximately 1-hour in length and included coaching and feedback. A single subject AB design was used to evaluate the effects of community instruction on caregiver AAC modeling. Frequency of caregiver modeling is the dependent variable measured by direct observation. Module development utilized behavior skills training techniques consisting of (a) instruction (b) modeling (c) practice (d) feedback and coaching in the community setting.

Cardiovascular disease (CVD) is the number one killer of women. Surprisingly, only about half of women are aware of this risk. Statistically, heart disease kills about 1 in 5 African American and Caucasian women. Lifestyle behavior choices such as obesity, lack of exercise, consuming an unhealthy highly processed diet, smoking, and an intake of greater than 1 drink per day of alcohol increases a women’s risk for CVD. These risk factors are avoidable. These lifestyle behavior choices are modifiable and with improvements to each behavior they will decrease the women’s risk. Health and Wellness Coaching is a proven intervention to improve lifestyle behaviors that negatively impact chronic medical conditions. The development of a tailored lifestyle self-management intervention by a Nurse Practitioner in a Nurse Practitioner Wellness Clinic will address each of the lifestyle behavior choices to ultimately decrease the risk of cardiovascular disease and provide education that allows these changes to be enduring.

Background: Substance use disorders have increased in the U.S. in the past 20 years, with opioid abuse causing over 70,000 deaths from 1999 to 2019. The growing public health problem necessitates developing a patient-centered educational toolkit. Patients on benzodiazepines who are at increased risk of morbidity and mortality are not engaged in their benzodiazepine management and need a specific educational tool to provide the necessary knowledge for medication management. In addition, there is currently no patient education to improve benzodiazepine safety or evidence-based program to enhance the partnership between the prescriber and the patient in many offices. Method/Design: The investigator developed an evidence-based patient education toolkit to enhance patients' knowledge about the safe use of Benzodiazepines and the risks of chronic Benzodiazepine use. Forty-one participants completed a voluntary pre, and post-survey focused on benzodiazepine-related knowledge and willingness to decrease or cease use. This improvement project aimed to (i) educate and improve the patients' understanding of safe Benzodiazepine use. (ii) Increase patient's readiness to decrease or ease long-term Benzodiazepine use. Participants: A convenient sample of 41 patients prescribed benzodiazepines at the behavioral health clinic was selected. Results: Results of linear regression indicated that patients improved their knowledge regarding safe benzodiazepine use after using the patient-centered toolkit. However, no statistically significant changes were observed in patient willingness to decrease or cease benzodiazepine use. Conclusion: The patient-centered toolkit is useful in improving patient knowledge regarding safe usage of benzodiazepines. However, the toolkit was not beneficial in changing the patients’ willingness to cease or decrease benzodiazepine usage. Nevertheless, findings are helpful in nursing practice and should be used to inform current practice. Future investigators should improve the toolkit by completing projects focused on how the toolkit can be made more effective or used in more focused interventions.

This researcher described the current Fee for Service (FPS) Model to gain information regarding Nurse Practitioner Service awareness in Pennsylvania and introduced the practice model of Direct Primary Care (DPC). The respondents provided information related to the research question of: What are community members' knowledge of alternative pay models for primary care services provided by a Nurse Practitioner? What are community members' willingness to participate in alternative pay models for primary care services rendered by a Nurse Practitioner? The research showed access problems as >70% of respondents indicated difficulty to scheduling an appointment taking more than 24 hours. It was determined that >28% of respondents found the DPC model more attractive than their current care model, an example of perceived value. This research showed scalability potential meaning other Nurse Practitioners who wish to pursue the DPC practice model in their geographical area could reproduce similar data collection efforts to learn the perception in their state or locality. It is believed that burnout associated with healthcare providers is high and DPC provides an alternative practice model to curb burnout, engage patients and heighten health outcomes while focusing efforts on a smaller practice size., Copyrights are retained by the author. Please contact Neal Garverick for further use of this material.

Can seniors learn what is included in an AWV through an educational presentation, thus leading to an increase in participation and possible improving of overall health? This study aims to investigate if an educational presentation will be effective in increasing the knowledge of an AWV for senior citizens through a pre and post-test. The pre- test and post test will assess their level of knowledge. It will be a quantitative study using a 10 question survey. The seniors will take the survey once before the presentation and then again after the presentation. The participants will be using a Likert scale to rate the importance of a variety of questions that are included in an AWV. Participants over the age of 65 will be eligible for the study, regardless of sex, gender, religious affiliation, or cultural background.

Breast cancer affects people all ages, genders, and races. The ways in which providers prevent and detect breast cancer have change significantly over the years. Healthcare providers have a number of resources to utilize to screen patients for breast cancer appropriately. However, providers do not always follow the guidelines that are recommended likely due to lack of knowledge. The purpose of this evidence-based quality improvement project was to increase healthcare provider knowledge about current breast cancer screening guidelines and recommendations. In August of 2024 over a two-week period, healthcare providers at a federally qualified health center look-alike were asked to participate in an evidence-based quality improvement project concerning breast cancer screening guidelines. Participants completed a pretest and posttest questionnaire to measure if there was an increase in knowledge after completing the presentation. Fifteen participants completed both the pretest and posttest. A paired-samples t-test was utilized to analyze data which resulted in a statistically significant finding. These results conclude that a breast cancer screening guidelines presentation helps to increase provider knowledge.

Cardiac arrest is a global issue. Research has been done over the years to create the golden standard within the American Heart Association (AHA) that chest compressions matter. The research now is advancing beyond just the quality aspect. The new knowledge of the quality has led more researchers into the specific timing which is known as the ratio of chest compression fraction (CCF) time. The initiative behind the implementation of this project was to address the problem that the institution did not have any means of measuring either the quality of manual compressions or the CCF. CCF is the time doing compressions divided by the overall time of the cardiopulmonary resuscitation event.

Education was provided to staff on ways to reduce interruption: pre-charge defibrillator, establish pulse prior to holding compression and hoover over the chest for next compressor on the opposite side of the patient. In addition to education on current protocols, a manual compression feedback device was used to monitor real-time feedback. Quality improvement implementation of the measurement of CCF. Data was collected by using a manual feedback device. Reviewing the quality % of compressions. Data was collected for baseline, then post-implementation of education regarding the importance of measuring CCF.

Data were compared for pre and post-intervention, by reviewing overall patient outcomes and looking at the 30-day post resuscitation mark. The post-intervention data included 10 patients. Six of the patients had CCF greater than 80%, Four events used the manual compression feedback device, and two with the mechanical compression device. Four patients had a return of spontaneous circulation at the time of the resuscitation event. However, there were zero survival patients at the 30-day post-resuscitation mark. The data had no difference between the pre and post-interventions for the 30-day survival rate.

Clinical inertia is the failure to initiate or intensify treatment in a timely manner in people with type-2 diabetes mellitus (T2DM) in primary care (PC) where collaborative care can be an approach to overcome inertia. Diabetes care network (DCN) is a telehealth based collaborative care model to address clinical inertia in the PC environment. In DCN, initial care was delivered via E-Consult by hub diabetes team for Veterans with A1c of 9% or higher and the longitudinal collaborative care delivered by PC liaison with weekly team huddle. To study the difference in the clinical outcomes with DCN vs PC practices, we compared the DCN cohort (97.7% male, 90.8% white, with a mean age 67.2 (8.9), with a PC cohort (100% male, 94.9% white, mean age: 68 year (10.5), with A1C >9%). Methods: Means (SD), frequencies. and percentages were presented. The DCN cohort had a significant decline in the baseline A1C of 10.2% (1.4), to 8.1% (0.99), 7.6% (0.96), 7.5 % (0.86) at 3, 6, and 12 months while A1c in PC cohort stayed poor with baseline A1C of 10.1% (0.89), to 10.2% (1.69), 9.7% (1.74) and, 9.5% (1.83) at 3, 6, and 12 months. Patients who achieved A1c less than 8% in DCN cohort were 38 (43.6%), 56 (64%), and 56 (64%) at 3, 6, and 12 months and were 1(1.7%), 5(8.5%), and 6(10.2%) at 3, 6, and 12 months in PC cohort. An A1c of less than 7% was achieved in DCN cohort in 10 (11.4%), 21 (24.1%), and 23 (26.4%) patients at 3, 6, and 12 months and only 1(1.7%), 0(0%), and 0(0%) patients achieved A1c less than 7% at 3, 6, and 12 months in PC cohort. Our study shows participation in the DCN telehealth program for 1 year was associated with significant improvement in A1c. This improvement was not seen within the PC with traditional care practices. Thus, addressing clinical inertia in PC will need a paradigm shift in current practices. The proposed collaborative approach of DCN can overcome clinical inertia in PC and improve care for people with T2D by supporting PC access to specialty care expertise, decreasing the burden of diabetes care for patients and PC providers.

Compassion fatigue, also known as secondary traumatic stress disorder, results from repeated exposure to the suffering of others, eventually exhausting his or her ability to show compassion. Self-care has been suggested as a potential preventative or treatment strategy in compassion fatigue however there has been limited documentation to validate this relationship. This study utilized a non-experimental, descriptive correlational design in order to determine if EMS professionals in Northwestern Pennsylvania, who practice self-care, experience less compassion fatigue than those who do not. A survey which was comprised of The Professional Quality of Life (ProQOL) scale, a validated tool for assessing compassion fatigue by evaluating secondary traumatic stress, burnout, and compassion satisfaction, as well as the Health Promotion Lifestyle Profile (HPLP) II, a tool to evaluate health promotion/self-care, was completed by 164 EMS professionals in Northwestern Pennsylvania. Spearman’s rank correlation coefficient was utilized to determine the relationship between self-care and compassion fatigue. The results demonstrated a negative correlation between self-care and burnout (p<.000), a negative correlation between self-care and secondary traumatic stress (p<.000), and a positive correlation between self-care and compassion satisfaction (p<.000), suggesting lower levels of compassion fatigue in those who practice self-care. These findings suggest that the implementation of self-care may result in decreased compassion fatigue, improving the EMS professional’s quality of life as well as patient outcomes.

During the COVID-19 outbreak in the spring of 2020, the nursing department responsible for facility-wide heart failure (HF) interdisciplinary communication was disbanded and redirected to other hospital needs. With that change and the subsequent lack of cohesive educational efforts, the hospital readmission rate climbed to 29.85%. This hospital system has consistently had readmission rates greater than the Centers for Medicare & Medicaid Services (CMS) national benchmark of 21.9%, which is both detrimental to our patients and the hospital to incur readmission penalties yearly. Before this program began there was no process to transition care from inpatient to outpatient for the HF population; key members that touched HF patients operated in silos. Based on consistently high readmission rates and the need for improved outcomes, a comprehensive HF discharge program was designed and implemented house-wide. Transitional care coordination includes providing education, scheduling post-discharge follow-up appointments, and providing HF toolkits. There was a retrospective analysis of data three months after the implementation of QI initiatives. Our facility’s all-cause 30-day readmission rate has progressively declined by 7.63% since the HF transitional program’s implementation (Study period 25.37% down to 17.74%). Readmission average rate for 2019 was 24.9% (n=241) (July 6-September 30, 2019) and compared to after implementation in 2020 was 22.56% (n=195) (July 6-September 30, 2020). Overall, we have found having an advanced practice provider (APP) led multi-disciplinary program to be the best practice for the HF population while improving outcomes and the ability for self-care while decreasing 30-day readmission.

Urinary tract infections (UTIs) are the most commonly treated infection among nursing home residents; patients are commonly treated even in the absence of signs or symptoms of a UTI being present. This research study’s objective is to reduce the amount of unnecessary antibiotic prescribing and assess the impact of educational interventions in nursing home residents that have asymptomatic bacteriuria (ASB). The design of this research study is quasi-experimental. The setting is Butler Memorial Hospital, a non-profit organization and an independent community hospital with 296 beds located in rural Pennsylvania. Population of interest includes nursing home residents that present to Butler Memorial Hospital’s Emergency Department with consecutive positive urine cultures. A multifaceted educational intervention will be provided to Emergency Department staff to reduce the number of unnecessary antibiotic prescribing in ASB cases. There were 105 in the sample population that resided in an institutional facility for the elderly that were seen in Butler Health System’s Emergency Department. Out of the DEFERRING ANTIBIOTIC PRESCRIBING IN NURSING HOME RESIDENTS WITH ASYMPTOMATIC BACTERIURIA 4 105-sample population, 73 were encountered before educational intervention. Twelve out of the 73 pre-educational sample population met the study’s inclusion criteria. Out of the 105 sample population, 32 were encountered after educational intervention. 4 out of the 32 post-educational sample population met the study’s inclusion criteria. In conclusion, this pilot study showed that there was a 3.9 percent overall reduction in nursing home residents that were being inappropriately diagnosed with a UTI and placed on unnecessary antibiotics when in fact they had ASB and met the criteria to defer prescription. While this was a small change the potential for changing prescribing habits with educational programs is encouraging and more studies should be done with larger samples sizes.

Background: According to the Centers for Disease Control, (CDC, 2018) at least thirty percent of outpatient antibiotics are unnecessary. A retrospective 2018 study by Incze, M.A., Redberg, R.F. and Katz, M. found forty nine percent of antibiotic prescriptions in the urgent care setting were for inappropriate diagnosis. The aim of this study was to educate providers on one method of reducing antibiotic prescriptions and incorporate new patient instructions into the electronic health record. Participants included physicians associates and nurse practitioners.
Methods: The Quality improvement approach of Plan Do Study Act was utilized for this project. A literature review was completed to study methods of antibiotic stewardship. The electronic health record system was queried for delayed prescribing discharge instructions. Informal discussions among providers revealed absence of a cohesive approach to reducing unnecessary prescriptions for antibiotics.

Interventions: A PowerPoint was emailed to all providers on the use of delayed prescribing for antibiotics along with a Likert-Scale survey on provider perceptions of implementation. New instructions for patients on delayed prescribing of antibiotics was added to the existing electronic health record system. For a period of 30 days the number of times delayed prescribing instructions sheets were printed for patients was monitored along with the number of patients seen at each location. The provider survey was also reviewed.

Results: Provider survey demonstrated favorable attitudes toward antibiotic stewardship. The delayed prescribing instruction set was utilized twenty-seven times over the thirty-day period. There were 2,579 patient encounters during the study for a 0.9% utilization rate.

Conclusions: This was a new process in the clinic where the study was completed and though the utilization was low there was favorable consensus among providers on the value of antibiotic stewardship. There are many opportunities going forward including tracking diagnosis codes along with antibiotic prescriptions and following up to determine how many delayed prescriptions were filled. This research can provide a starting point for any outpatient facility looking to decrease rates of antibiotic prescribing.

Long-acting injectable antipsychotics (LAIs) are underutilized pharmacological treatment options for those with schizophrenia. Research examining psychiatric prescribers' relationship with LAIs hypothesized that their knowledge deficits, uninformed attitudes, and poor prescribing practices contribute to the underutilization of LAIs in clinical practice. There is a gap in the literature regarding educational interventions to address psychiatric prescribers' knowledge deficits, uninformed attitudes, and poor prescribing practices. The purpose of this Doctor of Nursing Practice (DNP) research project, based on the Knowledge to Action Framework, was to develop and evaluate the impact of a web-based educational toolkit on the knowledge, attitudes, and practices of psychiatric prescribers. A seven-part web-based module that included a presentation of the created educational toolkit regarding LAIs and a before and after knowledge, attitudes, and practices questionnaire was hosted on an online-open source learning management system and disseminated to psychiatric prescribers. Findings indicated that the web-based educational toolkit slightly improved the knowledge, attitudes, and practices of psychiatric prescribers regarding LAIs. It also revealed a relationship between a positive change in attitudes and psychiatric prescribers practicing in a hospital setting. This DNP research project reflects the essentials of the DNP degree. It contributes to the body of knowledge of psychiatric nursing, created a lasting reference tool for prescribing LAIs, filled gaps in the literature regarding LAIs, supports the use of continuing web-based education and toolkits, and serves as a catalyst for other studies regarding LAIs.

Patients who are receiving comfort-directed care at the end of their lives will be cared for by nurses throughout their hospital stay. Providing bedside end-of-life care requires specialty assessment, communication, and intervention skills. Nurses who provide bedside end-of-life care in the acute care setting may not receive specialty palliative care training as part of their undergraduate education. To address this an educational curriculum was designed by members of the Palliative Care team and a Palliative Superuser training program was developed. Guided by the Comfort ALways Matters (CALM) framework the course focused on specialized assessment and symptom management, holistic approaches to patients and their caregivers, and communication instruction. Course description is a four-hour workshop presented by certified registered nurse practitioners from the inpatient palliative care team. Nurses who complete the superuser training will act as mentors to their peers and will continue to receive educational updates every two months. A goal of training ten percent of nurses in the acute hospital setting was set. Individual class size is limited to 10 attendees to facilitate small group discussion. Program availability was advertised by email and flyer to the managers of all inpatient units. Nurses who expressed interest and volunteered to attend were chosen by their managers and enrolled in the class. Pre- and post- testing of nurses who volunteered for the training revealed improvement in knowledge, confidence, and comfort in providing end of life care after completing the initial training session. Early positive results of the QI initiative suggested that ongoing training will be valuable to the institution and the patients.

Background: The problem of interest is focusing on an increase for education within the forensic interviewing process for individuals within the multidisciplinary team and community stakeholders. The PICO question is: Does the development of an assessment tool kit for the child forensic interviewing process increase knowledge of qualified observations evidence by the multidisciplinary team and stakeholders. The Theoretical foundation for this research will aim to develop and present a toolkit that will enhance and positively affect the knowledge and practices of the forensic interview, based on the Iowa Method of Evidence-Based Practice and a Knowledge-to-Action structure.

Methods: Methods utilized a pre-survey, presentation, and post-survey; which entailed an example of setting the stage introduction, rapport, encouraged narrative, facilitators, interview instructions, narrative practices, and follow-up questioning. The analysis of the forensic interview consisted of a model structure in which the multidisciplinary team was given a pre-survey questioning acquired knowledge from previous education, a presentation entailing a structured conversation with a child intended to elicit detailed information about a possible event or events that the child has experienced or witnessed, and a post-survey that measured knowledge gained.

Results, conclusion, implications, and recommendations: The scholarly project gathered information through the pre/post surveys focusing on assessing the information interviewers typically review prior to conducting the forensic interview. The surveys revealed a lack of uniformity within the protocols and the preparation practice, as well as the observational viewers. Summary of data collected, there were limitations to the results which stemmed from a lag in the post survey sent out, as well as a decrease in response from the attendees. In conclusion, there was evidence of learning, which was observed through the results obtained.

The Pearson correlation was used with the result sought after to determine if there was a linear relationship between two quantitative variables, whether a positive or negative correlation. In this scholarly study, the variables were the pre and post survey measuring gain of knowledge by participants. Each question results were reviewed as data to the survey response, with a total of ten questions; both pre and post survey. The pre-survey there were 19 responses. The post-survey resulted in nine out of nineteen responses. Four questions had no statistical significance, however, the remaining questions relating to rapport with the child, impartial attitude, ground rules of the interview, appropriate process, open-ended questioning, and a value with discoverable evidence demonstrated a statistical significance.

This study evaluates the impact of training on providers’ confidence about using the MinuteClinic (MC) hypertension (HTN) guideline to conduct HTN management visits in MC. MC providers who participated or did not participate in the training/webex education sessions provided prior to the commencement of HTN chronic care services were surveyed and their confidence scores measured. T-test analysis did not show any statistically significant difference between the Trained group and the Non-Trained group. Factors enabling the lack of significant difference between the two groups and suggestions for further studies are discussed.