Nursing (Doctor of Nursing Practice)

This study was a non-experimental, cross-sectional design with retrospective electronic medical data review to assess the effectiveness of an EMR intervention in Hepatitis C Virus (HCV) screening for those born between 1945-1965 birth cohort. The study measures three months pre-EMR provider prompt and three months post-EMR provider prompt. Screening, statistically the patients who met HCV screening criteria increased from 27.9% to 72.1% post-EMR provider prompt screen. With the increase in screening, the study showed an increase overall HCV testing from 5.6% to 37.6% post-EMR provider prompt screen. This increase in both screening and testing for HCV, allows the possibility to capture those undiagnosed Hepatitis C patients and provide the patient with appropriate linkage to care to decrease overall morbidity and mortality within the given birth cohort. The success of utilizing an EMR prompting system, will allow the opportunity for further research in other aspects of health maintenance.

There is existing research noting a possible correlation between vitamin D insufficiency and irritable bowel syndrome. The etiology of irritable bowel syndrome is unknown with the goal of the health care provider being symptom control. There are studies suggesting insufficient vitamin D levels may cause an inflammatory response in the gut leading to symptoms of irritable bowel syndrome. Out of 118 patients in a private gastroenterology practice in rural Western Pennsylvania, 62 individuals with the diagnosis of irritable bowel syndrome had vitamin D blood levels drawn within the last 5 years. The diagnosis of irritable bowel syndrome was broken down into IBS/ diarrhea, IBS/ constipation, and IBS/mixed. The expected value from the Chi-Square test as derived from a proportional analysis of low vitamin D levels in the general population of the United States is 19.8. The observed value from this study is 30, a 10.2 value higher than the expected value. The Chi-square test indicated significance, thereby the (30) IBS patients (48.3%) the total patients with low levels of vitamin D as compared (32) IBS patients (51.1%) of the total patients with normal levels of Vitamin D, where Chi-square (1, n = 62) = 7.6, p < .006. The study showed a possible correlation between insufficient vitamin D levels and irritable bowel syndrome in a small rural gastroenterology practice in Western Pennsylvania. Further investigation into a possible correlation between vitamin D insufficiency and symptoms of irritable bowel syndrome in the adult patient would be a positive step towards this challenging functional bowel disorder.

The aim of this study was to evaluate the difference in patient satisfaction scores between lesbian, gay, bisexual, transgender, questioning or queer, intersex, and asexual (LGBTQIA+) individuals who receive healthcare from LGBTQIA+ inclusion clinics and LGBTQIA+ individuals who receive healthcare from traditional clinics. LGBTQIA+ individuals have unique healthcare needs and require safe, affirming, culturally competent, and inclusive healthcare environments that will meet these unique needs, eliminate health disparities and inequities, and improve patient reported outcomes such as patient satisfaction.

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.

The purpose of this evidence-based practice project is to evaluate the effectiveness of a pilot mental health knowledge questionnaire tool used to assess for change in knowledge. Currently, there are limited tools being used to assess mental health and depression knowledge in vulnerable communities. This study’s objective and goal is to improve the current practice for community mental health education in vulnerable communities with the intent to increase awareness and dispel cultural misconception of mental health. A self-reported pre-test was administered to assess baseline knowledge of mental health and depression followed by the educational program on mental health and depression. The data was analyzed utilizing the Statistical Package for the Social Sciences (SPSS) 23 for descriptive and inferential statistics. The scores from a paired t-test were compared to determine the effectiveness of the educational intervention. This study sought participants aged 18 and older, fluent in speaking, reading, and understanding English. The findings reflect a positive improvement in knowledge recorded on the post-test responses. Results also showed an increase in correct responses on the post-test after the implementation of the mental health depression educational program. Finally, the promotion of educational programs on mental health and depression in vulnerable communities are beneficial in bring awareness of mental illness.

Colorectal cancer is a leading cause of death in the United States with colonoscopy fundamental to any colorectal cancer screening program. Open access colonoscopy allows procedures to be performed in a timely manner to detect adenomas. The efficacy of adenoma detection is largely dependent on the quality of colonoscopy bowel preparation. Adenoma detection rate of open access screening colonoscopies and quality of split dosed bowel preparation was measured in a rural private gastroenterology practice in Central Pennsylvania using the 2017 Registry Individual Measure Flow created by the Centers for Medicare & Medicaid Services (CMS) noting the quality of bowel preparation at time of review. Open access screening colonoscopy reports were reviewed for ICD-10 codes for 3 risk factors for colorectal cancer, age 50 years and greater, and CPT codes for colonoscopy procedure without modifiers resulting in early termination of the procedure. The annual adenoma detection rate of open access screening colonoscopy patients who met the inclusion criteria was 44.47 % with 96.7% of open access screening colonoscopies rated to have optimal bowel preparations. These findings suggest that open access screening colonoscopy can be a timely, patient-centered method of effective, high quality colorectal cancer screening.

This descriptive study explores the reasons individuals bringing their child(ren) to the pediatric office are not using the patient portal. There was negligible use of the patient portal as shown by a retrospective review of data usage reports via the eClinicalWorks software. Additionally, staff reported that they still answered many calls for information (immunization records, lab results, medication refills, appointment scheduling, and care-related questions), all of which were easily obtained through the portal. The objective of this study is to determine the reasons why individuals bringing the child(ren) to a rural pediatric practice in Central Pennsylvania are not using the patient portal. The scope of the survey is broad, as overall knowledge of the patient portal and its capabilities is assumed to be low based on current usage data. A convenience sample of individuals was pursued. The survey questions focused on the potential contributing factors to the individual’s lack of portal usage. Demographic data were obtained as part of the survey to identify the characteristics of the participants. The results revealed that the lack of patient portal usage would be responsive to change with some practice planning and education.

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.

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.

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.

Sepsis is a clinical condition that requires early identification and initiation of evidence based interventions to improve mortality and outcomes. A quality concern that has been
identified is that the emergency department at the practice site is not actively screening for sepsis patients. This has resulted in difficulty meeting three-and six-hour sepsis
bundle metrics. The purpose of this quality improvement project is to implement a sepsis screening methodology to correct this gap in practice. The door to lactic acid collection metric will be used to determine if any statistical improvement was made after the implementation of a sepsis screening tool. The screening tool selected for the project will be the qSOFA tool as this is one of the easiest tools to use and implement. The quality improvement project used a quantitative methodology with quasi-experimental design. The results demonstrated a statistically significant improvement in the collection times of lactic acid post-implementation. The results further support the use of sepsis screening in the emergency department setting for rapid identification and treatment of sepsis conditions. Emergency nursing plays a pivotal role in the identification and treatment of this condition as nurses are often the first healthcare professional a septic patient will encounter.

Atrial fibrillation is the most common dysrhythmia and has significantly impacted healthcare staff and systems. Catheter ablations remain the most effective tool in the treatment of
atrial fibrillation, and yet these have often contributed to hospital admissions and costs. Sameday discharges are a safe and cost-saving method being used more in this patient population. This study was completed to evaluate and compare same-day discharge versus admission following catheter ablation.

In the study, there were 321 patients who underwent catheter ablation for atrial fibrillation over 12 months from July 2021 to July 2022. Of these 321 patients, there were 74 same-day discharges. 30-day readmission rates for both samples were similar, with 4 (4%) patients readmitted following same-day release and 3 (2%) patients readmitted following observation or inpatient admission. 90-day readmission rates for both samples were also similar at 2.7% for same-day discharges and 1.2% for observation/inpatient admissions. There was a cost savings of at least $37,000 using same-day discharge versus at least $123,000 in costs for admission for observation or inpatient. Based on this study, the use of same-day discharge in catheter ablation for atrial fibrillation is reaffirmed as safe and cost-effective and should be considered in routine practice.