Nursing (Doctor of Nursing Practice)

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.

Background: Hypertension, or high blood pressure, is a chronic medical condition characterized by elevated blood pressure levels persistently exceeding the normal range. Hypertension is a crucial public concern and the leading cause of kidney disease and cardiovascular diseases, including heart attacks and strokes, and is the most frequent diagnosis seen in medical treatment in the US and worldwide. Adequate education, lifestyle modifications including physical activity, heart-healthy diets, and medication adherence are essential for patients with high blood pressure to be able to manage their disease and live with the best quality of life. Many studies have indicated the effectiveness of educational programs in reducing blood pressure and improving the health status of patients with hypertension.

Aims and Objectives: The purpose of this evaluation is to determine whether a formal single hypertension educational program will improve knowledge of management, increase motivation to change health behavior, and improve and promote medication adherence among the senior population.

Design: A pre-test and post-test study were conducted.

Methods: In this evidence-based education program, 33 older adult patients were recruited from the senior citizen community-based center in Philadelphia, PA. The intervention included education focused on improving knowledge of blood pressure, lifestyle changes, medication adherence, and motivation for behavior change. Outcomes were measured utilizing The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HB-Scale) and Hypertension Knowledge Test (HKT), a 12-item National Heart Lung & Blood Institute questionnaire.

Results: The program showed promising results that have positive implications for future practice and research. Of the participants that completed the study (N=33) of African descent, 27.7% were of Caucasian descent, 72.3%, 60.61 % were women, and 39.39% were men. The data collected reflected the participants' intentions regarding disease knowledge, medication adherence, and behaviors pre- and post-intervention. Findings suggest that community-based tailored education programs can successfully produce better HTN management by increasing hypertension knowledge, improving adherence to treatment regimens, and encouraging lifestyle changes among senior adult populations.

Conclusion: This educational intervention successfully identified improvement in senior adults' knowledge and increased motivation to change their blood pressure management health behaviors, leading to improved blood pressure control. It is hoped these results will be more widely used. Further investigation and future research would be more effective in meeting these goals in later programs to gain a more in-depth understanding of managing hypertension among senior adult communities.

In the United States, childbirth represents a significant reason for hospitalizations among reproductive women. There is potential for postpartum complications that may require the mother to go back to the hospital for needed treatment after discharge. Early postpartum interventions have shown promise in reducing the rates of readmission. One such intervention is to conduct a discharge phone call to support the transition from frequent prenatal visits and hospital stay monitoring to home. The discharge phone calls present an opportunity to enhance patient education and care, which could potentially lower readmission rates. Early recognition and interventions have proven to improve overall morbidity and mortality for postpartum women. This program evaluation assessed whether implementing discharge phone calls within seven days would reduce the 30-day all-cause readmission rate among postpartum women aged 18 years and older at a tertiary care hospital. A quasi-experimental, pre-post design compared data collected from March 2023 to August 2023 with data from March 2024 to August 2024. Retrospective chart reviews were utilized to capture readmission data and related variables. Discharge phone call data was collected using the healthcare system network standard discharge phone call form. The findings suggest that timely discharge phone calls can enhance post-discharge care by addressing patient concerns and reducing the likelihood of readmission.

Research has supported health literacy as one of the determinants in diabetes management (Fang et al., 2020; Kim & Utz, 2019; Robatsarpooshi et al., 2020; Van der Heide et al., 2014). Low health literacy has led to poor health outcomes in diabetes management (Poureslami et al., 2017; Van der Heide et al., 2014; Wang et al. et al., 2016). Research lacks interventions aimed at improving diabetes self-management for individuals with low health literacy (Jiang et al., 2019; Kim & Utz, 2019; Vandenbosch et al., 2018). This doctoral quality improvement project aims to evaluate the relationship between health literacy and diabetes self-management skills after participation in a web-based educational pilot program for adult patients with Type 2 diabetes in a rural community in Western Pennsylvania.

Families entrust their children to school staff with the expectation that they will keep their children healthy and safe for an average of seven hours a day. The reality is, medical emergencies due to trauma or illness, can occur at any time, whether it involves an adult or a student. From individual medical events to mass illness or injury events, school nurses are expected to be prepared to respond, while often being the only healthcare provider in the building. However, many school settings have no school nurse available to them, or the nurse is not employed full-time. Literature shows that school faculty and staff are often not trained to respond to medical events or have knowledge of student healthcare needs.

Cardiovascular disease continues to be a global health concern and is responsible for more than 17 million deaths every year. In the United States, readmissions for heart failure and heart attacks cause financial strains on the healthcare system. The Centers for Medicare and Medicaid have reduced reimbursement for readmissions for some cardiac issues, which has caused healthcare systems to find ways to prevent these readmissions. Patient education has proven to decrease readmissions in the heart failure population; however, there are some issues with nurse compliance for various reasons. A quality improvement project completed in the Cardiac Intensive Care Unit (CICU) aimed to determine if nurses would be more compliant with documenting disease-specific education topics on post-myocardial infarction patients if it was auto-populated in the electronic health record based on specific parameters. Prior to the intervention, compliance with documentation was 40%. After the education was auto-populated, compliance increased to 83%. There was also an increase in compliance with documentation on the telemetry unit as well. A survey was conducted with the CICU staff; 93% of staff felt they were more compliant, and 100% said the process was easier than remembering to add the education. Many staff gave examples of other education they would like to be auto-populated. Further research is needed to assess whether this education will decrease the readmissions of this patient population and partnerships with the electronic health record companies to streamline the education documentation process.

Health literacy is a critical determinant of health outcomes, influencing patient engagement, health care costs, and readmission rates. Despite its importance, many hospitals lack standardized tools to assess health literacy, leading to inadequate patient education, especially among vulnerable populations. This study evaluates the impact of implementing the BRIEF Health Literacy Assessment Tool in an inpatient setting to improve nurses' ability to identify low health literacy and tailor patient education accordingly.

Orem's Self-Care Deficit Nursing Theory (SCDNT) underpins this study, emphasizing the importance of assessing patients' ability to understand and manage their health. A quantitative correlational design was used. Nurses on a medical-surgical unit administered the BRIEF Health Literacy Assessment Tool to patients upon admission. Patients identified with low health literacy received supplemental education. Data on patient outcomes (length of stay, 7-day and 30-day readmission rates) and nurse feedback were collected and analyzed. Of the 40 patients assessed, 37.5% were identified with low health literacy. No significant differences were found in patient outcomes. However, nurses reported the tool as valuable and feasible, enhancing their ability to provide equitable patient education. While the tool is valuable to nursing, further research with larger sample sizes is needed to evaluate its impact on patient outcomes.

This study suggests that integrating such tools into nursing practice can enhance care quality and equity. Future research should involve larger sample sizes, multiple units, and longer implementation periods to better understand the impact of health literacy assessments on patient outcomes.