Nursing (Doctor of Nursing Practice)

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.

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.

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.

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.

Nurse residency programs (NRPs) have been instrumental in assisting to bridge the theory-to-practice gap commonly experienced by new graduate nurses (NGNs). NRPs have also proven useful in improving retention, work satisfaction, confidence, and competence (Spector, et al., 2017; Ulrich, et al., 2010; Rosenfeld, & Glassman, 2016). Despite the overwhelming literature to support implementation of NRPs in all hospitals, to date, in the United States, only 31 hospital sponsored NRPs are accredited by the Commission on Collegiate Education in Nursing (CCNE) (AACN, 2019). Currently, public documentation on the number of NRPs accredited by the American Nurses Credentialing Center (ANCC) are unavailable. Additionally, in Pennsylvania, only 2 hospital sponsored NRPs have obtained national accreditation. NRP accreditation holds health care organizations accountable and proves these programs have demonstrated quality. For an organization to undergo a significant change initiative, such as accreditation, a state of readiness must be present or created (Franquiz & Seckman, 2015).

Problem Statement: According to the U. S. Preventive Services Task Force (2018), Falls are the leading cause of injury that are related to morbidity and mortality among older adults in the United States. In 2014, about 28.7% of adults aged 65 years or older had a history of fall resulting in 29 million falls in which about 37.5% required medical treatment or encountered restricted activity for a day or more while an estimated 33 000 resulted in death in 2015 (USPSTF, 2018). This is estimated to increase to seven falls per day by 2030 which makes it an important topic to address (CDC, 2021).
Objectives: The purpose of this project was to improve safety by conducting a retrospective review of a Quality improvement (QI) measures of an evidence-based fall prevention program in Assisted Living. PICO research question was identified as P- Older adult residents, I- Evidence Based Fall Prevention Guideline C- Comparing before and after fall prevention programs, O- Decrease in falls.
Methods: This research was completed in Southern New Jersey, United States. Participants were required to be at least 65 years of age and older. The squire guideline 2.0 was well used in this QI article. This study evaluated a QI fall prevention protocol of Physical Therapy (PT) that was instituted in the Assisted Living Facility (ALF). Data were obtained from EHR and paper records. For the purpose of this study, fall was defined as an inpatient’s unknowing, sudden drop to the floor with or without injury, regardless of height of drop, whether assisted or unassisted to the floor (NDNQI, 2020). A weekly number of falls were retrieved 6 weeks before intervention and 6 weeks after. Data was analyzed using t-test to compare outcomes and propose policy change.
Intervention: The IOWA model was used to do a retrospective review of the success of the program. It was used at the beginning of the QI project as a foundation for the project. The Iowa Model helped direct decision-making and EBP process from both the clinician and system’s point of view (Iowa Model Collaborative, 2017). This 12-week fall prevention program focused on falls before and after physical therapy for individuals 65 years and above. The EBP fall prevention program of PT was instituted during week 7 and monitored by all team members.
Result and Conclusion: Using the paired t-test analysis, findings revealed a significant difference in pre and post intervention of p< 0.05. There was a decrease in the number of falls post intervention when compared to pre-intervention data. All data are presented in graphs, charts and tables for description. This paper has about 51 pages including references and appendix with tables and graphs of statistical importance. All tables and graphs are original work of the authors. The pages can be reduced as the reference pages currently list all tables, graphs and figures already used in the body of the article. Given the large audience to your publication, this article will be very valuable to your professionals. It will help educate them or reinforce knowledge on how to reduce injury and high cost of care that are incurred from falls, and improve overall safety.

Migraines are a common and debilitating medical issue. Many patients are turning to complementary and alternative medicine to either augment or replace conventional medical treatment for this. However, it is unclear what their primary care providers’ attitudes are toward the use of CAM and the PCP’s knowledge base in this area. This study was designed to determine PCPs’ attitudes towards CAM and if a brief educational presentation regarding CAM modalities frequently used for migraines had any impact on their attitude towards CAM. There was a pre survey, a Power Point presentation discussing common CAM used for migraines, and a post survey. This was a small study, with 13 participants completing the pre survey and 10 completing the post survey. There was no significant difference between the pre and post intervention groups (p=0.46, significance level of <0.05). However, both groups had a mostly favorable attitude towards CAM. Gender, work setting, and credentials did not impact attitudes towards CAM. Acupuncture, relaxation therapy, massage, and chiropractic care were the CAM modalities that the providers felt the most comfortable discussing. The findings from this study can be used as a guide for future educational offerings and CAM services in the area. Suggestions for future research include offering a continuing medical education credit to boost participation.

Overweight and Obesity is defined, according to the CDC, as a weight higher than what is considered healthy for a given height (CDC, 2021). This is calculated using a screening tool for overweight and obesity. Overweight is regarded as a BMI of 25-30, and obesity is greater than 30. The latest data shows that adult overweight and obesity is increasing and has become a major global epidemic. Overweight and Obesity is a very complex health issue that has resulted from a combination of factors, including behaviors. This includes poor dietary patterns and inactivity. Lack of education in healthy nutrition is one of the issues contributing to overweight and obese adults. Other reasons can be psychosocial barriers that can include fear of judgment and uncertainty about the process of seeking help if one is obese. Other obstacles can consist of time commitment and the cost of programs. Being overweight and obese can lead to increased health risks like diabetes, heart disease, stroke, and certain cancers. According to the CDC, obesity is also associated with the leading causes of death in the United States (CDC, 2021). With this comes a significant economic impact as well. This small pilot study used participants in a brief online asynchronous. The criteria were people ages 18-65. Each volunteer participant gave written consent to participate and be evaluated during the program. Each volunteer participant answered the preprogram questionnaire, watched the virtually based PowerPoint presentation linked under YouTube, and then answered the same questionnaire to assess their new knowledge and willingness to change to a healthier lifestyle. The General Nutrition Knowledge Questionnaire was the tool used for evaluation. This questionnaire is a valid measure of nutrition knowledge that is consistent and reliable.

The virus responsible for Covid-19, acknowledged as a public health threat, has been causing global disease since it was first discovered in December 2019 in China. The CDC (2021) issued a call for action through its Science Agenda for Covid-19 to identify evidence-based interventions for interrupting disease progression in vulnerable populations such as those in emergency shelter settings.

This project focused on Covid-19 and its impact on the homeless population in northwestern Pennsylvania. The theoretical framework was the John Hopkins Evidence-Based Practice Model (JHEBP). A survey collected self-reported data on the practice and barriers to using personal non-pharmaceutical interventions (NPIs). Participants were adults ages 18 and over in one of two emergency shelters on the data collection date.