Nursing (Doctor of Nursing Practice)

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.

Alcohol Use Disorder (AUD) is a chronic medical condition characterized by an impaired ability to control or stop the use of alcohol, despite the adverse social, occupational, and health consequences (APA, 2013; Witkiewicz, Litten & Leggio, 2019). The purpose of this study was to identify the presence of stigma and perceived negative attitudes of nurses working with patients diagnosed with AUD in all areas of practice, with the aim of decreasing stigma and enhancing positive attitudes in nurses caring for patients with AUD through an educational intervention. The literature is well established that nurses feel unprepared educationally to care for patients with AUD, and also hold negative attitudes and perceptions of working with patients with AUD (Haskins, et. al, 2014). This research will conduct a pre-and post-survey of registered nurses’ attitudes and perceived stigma followed by an educational intervention to evaluate whether the education is a positive critical element that can help to reduce stigma and improve negative attitudes nurses may hold toward caring for patients with AUD. This research is a quality improvement project to collect and use data that is meant to drive change that has practice and policy changing implications. The Seaman-Mannello Survey was used as a pre-and post-survey to measure the efficacy of the interventional education video. A convenience sampling of 76 registered nurses from three Northwestern Pennsylvania hospitals was used. The goal of this research study was to investigate the effectiveness of an educational intervention that, if significantly effective, can be used on a larger scale to decrease stigma and improve attitudes of nurses toward patients with AUD. The results found no significant relationship between the provided educational intervention and reduced stigma or improved attitudes of nurses while working with patients with AUD. Although a positive relationship could not be established, it was inferred from the pre-and post-survey scores, ongoing education is still needed and may impact the care of individuals with AUD.

Heart failure (HF) readmissions are incredibly burdensome to hospitals across the country. In 2020, approximately $563 million in penalties from the Center for Medicaid and Medicare Services (CMS) were assigned based on higher than average admission rates (Allen, 2019) with a significant portion related to HF. Our facility has consistently had readmission rates higher than the CMS national benchmark. This is both detrimental to our patients and the cause of assessed yearly CMS reimbursement penalties, which significantly impacts payment for care delivered. There has historically been a very incomplete and disjointed care transition post-discharge for our HF population.

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.

In hospitalized patients, the transition from hospital to home can lead to adverse events, negative outcomes, ER visits, and hospital readmissions (Backman et al., 2021). A poor transition of care can also be reflected in low Care Transition scores in HCAHPS surveys. The Care Transition questions reflect how well the patient felt prepared to manage their own care at home.

This quality improvement initiative answered the following research question: “In hospitalized adult patients, how does collaborative care transition planning compared with traditional discharge planning affect Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores one month after implementation”?

The theoretical framework is Larrabee’s model of Evidence-Based Practice. Methods include comparing the Care Transitions scores the month prior to implementation to those from the month following implementation.

There was a decrease in scores the month during implementation, but then increased in the month after. While not a part of the initial data collection, there was also an improvement in patients’ average length of stay. It can be concluded that the increase in communication amongst the healthcare team during the huddle did play a part in the efficiency of managing patients’ plan of care.

The nursing implications include the need for increased communication. When the healthcare team works together, it improves the patients’ transition from hospital to home. Future research may focus on length of stay as an important variable. A limitation of this study was a lack of consistency in collaborative rounding. Additional research in this area is needed.

On average, humans spend one-third of their lives fulfilling basic sleep needs (Cirelli, 2019). Theories suggest that sleep improves immune responses, reduces energy, allows for the recuperation of cognitive functions, and removal of waste; however, the exact function is unknown (Zielinski, McKenna & McCarley, 2016). Research has revealed when sleep is chronically disrupted the individual experiences a reduction in their quality of life, an increased risk for mortality as well as cerebrovascular and cardiovascular events (Chattu, Sakhamuri, Kumar, Spence BaHammam & Pandi-Perumal, 2018). Ever changing variables that affect sleep in the hospital setting have created a need to ask the question, what happens when such disruptions occur in an environment like the hospital? Therefore, the primary purpose of this study was to identify adverse outcomes associated with insufficient sleep experienced by hospitalized non-critical older adults in literature.