Nursing (Doctor of Nursing Practice)

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.

Clostridium difficile is a microbe that may cause a severe intestinal infection in vulnerable individuals such as those who are ill and taking antibiotics, or the elderly living in skilled care facilities. Use of probiotic supplements have shown in some studies to decrease the incidence of Clostridium difficile infection (CDI). Does the use of probiotic supplements in residents of a skilled nursing facility in western Pennsylvania receiving antibiotic therapy reduce the incidence of CDI? This retrospective study reviewed electronic medical records of 164 residents in a skilled nursing facility, including residents receiving antibiotics, and those receiving antibiotics and probiotics. Limitations included the size of the study sample, the age and condition of the patient including possible previous CDI history, and the time frame of transposition of laboratory analysis results to the electronic medical record. Results revealed a statistically significant difference in the rate of antibiotic-related diarrhea between patients receiving antibiotics and those receiving antibiotic therapy with probiotic supplements. In this study, no patients receiving probiotics and antibiotics were positively diagnosed by laboratory analysis with CDI. This study indicates the need for further studies related to use of probiotic supplements in patients receiving antibiotic therapy.

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.

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.

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.