Nursing (Doctor of Nursing Practice)

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.