Journal of Doctoral Nursing Practice最新文献

{"title":"Implementing Effective Care Through Utilization of Diabetes-Focused \"Right Care\" Visits in a Suburban Primary Care Setting.","authors":"Tricia Neu,&nbsp;Christopher Eppley,&nbsp;Kristin Gianelis","doi":"10.1891/JDNP-2022-0008","DOIUrl":"https://doi.org/10.1891/JDNP-2022-0008","url":null,"abstract":"<p><p><b>Background:</b> Diabetes is the seventh leading cause of death in the United States and the leading cause of lower limb amputations, adult-onset blindness, and renal failure. It is estimated that 34.2 million Americans have a diabetes diagnosis, and the prevalence of this condition has continually increased over the last two decades. This study includes patients at a large, suburban primary care practice in southwest Ohio who were considered to have uncontrolled diabetes based on their last Hemoglobin A1c of greater than 9%. Compliance with recommended annual screenings among this population was 15%. <b>Objectives:</b> The aim of this project was to improve glycemic control and increase the number of patients who received the recommended annual screenings through the implementation of nurse practitioner-driven, diabetes-focused \"Right Care\" visits.C <b>Methods:</b> This quality improvement pilot study consisted of interventions implemented over the four plan-do-study-act cycles. Each cycle included a test of change that was identified based on data from previous cycles to ensure continuous improvement throughout project implementation. Four interventions were evaluated including the utilization of a diabetes registry, implementation of a \"Right Care\" checklist during \"Right Care\" visits, use of a patient engagement tool with a focus on individualizing diabetes medication regimens, and implementation of a team-engagement plan. <b>Results:</b> Average Hemoglobin A1c reduction was 2.4% post-\"Right Care\" visit. Compliance with the annual screening bundle increased to 44% over 8 weeks. Utilization of the patient/provider relationship increased visit compliance by 18%, and the team engagement plan decreased work-related stress by 12%. <b>Conclusions:</b> The implementation of \"Right Care\" visits led to improved glycemic control and increased compliance with the recommended annual screenings among patients with an A1c greater than 9%. The patient engagement tool identified key factors related to diabetes medication adherence and team engagement decreased work-related stress and improved annual fundoscopic exam screening compliance. <b>Implications for Nursing:</b> Nurse practitioner-led \"Right Care\" visits utilize the knowledge and skills of advanced practice registered nurses to improve glycemic control in patients with uncontrolled diabetes.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9903849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of an Office-Based Strategy on Treatment Outcome and Adoption of Measurement-Based Care Into Psychiatric Treatment at a Nonprofit, Outpatient Clinic.","authors":"Deirdre O Rea,&nbsp;Jeannie Garber","doi":"10.1891/JDNP-2021-0042","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0042","url":null,"abstract":"<p><p><b>Background:</b> Measurement-based care (MBC) is a method for demonstrating performance outcomes but is rarely used in behavioral health settings despite it being an evidence-based practice. As psychiatry moves to value-based care and payment for performance, the adoption of MBC will be essential. <b>Objective:</b> The purpose of the study was to test proactive reporting of patient self-reported measurement tool results to providers on treatment outcomes to promote the adoption of MBC. <b>Methods:</b> The study entailed a mixed methods design with a pre-/post-test quantitative measurement of scores on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 and a semistructured qualitative interview with providers following data collection. <b>Results:</b> Results showed, during the intervention period, statistically significant decreases in anxiety scores for all patients. Depression symptom decreases trended toward significance for female patients. After initial disregard for scores, all providers found a benefit to continued use of MBC. <b>Conclusions:</b> Identification and removal of barriers can assist in the adoption of evidence-based practices in healthcare. <b>Implications for Nursing:</b> Successful change can be accomplished with minor adjustments to an already-established workflow and a team approach to the process.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692110","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Clinical Outcomes of Implementing Diabetes Self-Management Education and Support in a Primary Care Practice: A Quality Improvement Project.","authors":"Candace Lee McGowen,&nbsp;Susan J Appel","doi":"10.1891/JDNP-2021-0046","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0046","url":null,"abstract":"<p><p><b>Introduction/Purpose:</b> Diabetes self-management education and support (DSMES) can be a very valuable service for many patients with diabetes. Unfortunately, despite its expected benefits, many patients do not receive DSMES through a quality, structured program. The purpose of this quality improvement project was to determine if integrating a diabetes education program utilizing the Association of Diabetes Care and Education Specialists (ADCES)7 Self-Care Behaviors into diabetes care in a primary care clinic could improve glycemic control and body mass index (BMI). <b>Methods:</b> The DSMES services provided were in accordance with the ADCES and the American Diabetes Association National Standards. The program included a 1-hour face-to-face service incorporating the ADCES7 Self-Care behaviors. A retrospective chart review was conducted to extract outcome data from <i>N</i> = 54 random medical records. This data was then analyzed to evaluate the program's effectiveness. Pre- and postintervention data from medical records were analyzed for eligible patients who participated in the DSMES service (ages 18-75 with type 2 diabetes, hemoglobin A1c [A1c] >8%). <b>Results:</b> Paired <i>t</i> tests were used to determine significant changes in BMI and A1c parameters pre- and postintervention. Preintervention A1c (<i>M</i> = 9.5, <i>SD</i> = 1.7) and BMI (<i>M</i> = 33.2, <i>SD</i> = 7.8) and postintervention A1c (<i>M</i> = 7.8, <i>SD</i> = 1.5) and BMI (<i>M</i> = 32.2, <i>SD</i> = 7.9) indicate that DSMES significantly reduced A1c, <i>t</i>(53) = 8.1, <i>p</i> = <.001, and BMI, <i>t</i>(53) = 4.4, <i>p</i> = <.001. Models were then adjusted for pretest measures, age, gender, and time since diagnosis in a regression analysis. In models adjusted for pretest measures, age, gender, and time since diagnosis was significantly predictive of the postmeasure of BMI (<i>B</i> = .41, <i>p</i> = .01, <i>R²</i> = .96) and postmeasure of A1c (<i>B</i> = .28, <i>p</i> = .04, <i>R²</i> =.41). <b>Discussion:</b> This project demonstrated that integrating a simple, cost-effective diabetes education service consisting of ADCES7 Self-Care Behaviors in a primary care practice could bridge gaps in diabetes management and significantly improve patients' BMI and A1c. Long-term utilization of this service may also enhance patient satisfaction, improve the patient's health, and reduce healthcare costs related to diabetes.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692111","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Seeing Through the Shadows: A Strategy to Improve Postpartum Depression Screening Practices.","authors":"Toni T Zappulla,&nbsp;Susan M Wechter","doi":"10.1891/JDNP-2021-0037","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0037","url":null,"abstract":"<p><p><b>Background:</b> The pilgrimage of this Doctor of Nursing Practice project was to bring postpartum depression (PPD) out of the shadows and into the light. A gap existed in a postpartum ambulatory setting with the screening, detection, and treatment of PPD. <b>Objective:</b> A quality improvement project with an evidence-based standard of care for PPD screening was implemented with every postpartum patient. <b>Methods:</b> The Edinburgh Postnatal Depression Scale-10 (EPDS-10; Cox, et al., 1987) was used as a reliable and valid screening instrument to screen 46 postpartum women. <b>Results:</b> Screening for PPD increased from 10.9% to 95.8% after the implementation of the EPDS. Referral and treatment of PPD increased from 1.8% to 19.6%. <b>Conclusion:</b> This project established an evidence-based standard of care that can be implemented with every postpartum patient and brought nine women out of the shadows with the hope that they can find the light to recover from PPD. <b>Implications for Nursing:</b> Screening for PPD is recommended by experts and is a Healthy People 2030 goal (ACOG, 2018; USPSTF, 2018). Universal screening with a validated tool may lead to improved compliance with screening, detection, and treatment of PPD. The outcomes of this project inform and prepare clinicians for the predicted mandate of national screening for PPD.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9692112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving Telenursing Skills Through Simulation-Based Education.","authors":"Sandra Parmeter,&nbsp;Cynthia Foronda,&nbsp;Jiye Lee","doi":"10.1891/JDNP-2022-0021","DOIUrl":"https://doi.org/10.1891/JDNP-2022-0021","url":null,"abstract":"<p><p><b>Background:</b> Preparing graduate-level nurses to provide care via telehealth could both increase access to care and decrease healthcare costs. However, many nursing schools do not provide telehealth experiences, especially at the graduate level. <b>Objective:</b> The aim of this project is to incorporate telehealth simulations in the doctor of nursing practice (DNP) curriculum at the University of Miami School of Nursing and Health Studies. <b>Methods:</b> This quality improvement project used a posttest-only design. The Ottawa Model of Research Use guided the project. DNP students completed a peer-to-peer telehealth simulation scenario via Zoom. <b>Results:</b> DNP students demonstrated confidence with an average score of 2.875 out of 3. DNP students' teaching performance scores were 2.7 out of 3. DNP students demonstrated effective overall telehealth performance with a mean score of 13.74 out of 15. <b>Conclusion:</b> DNP students may benefit from increased opportunities to practice telehealth, including the use of peer-to-peer simulation, to be aptly prepared for contemporary nursing practice.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing HPV Vaccination Rates in the Primary Care Setting.","authors":"Lynn-Marie N Charles,&nbsp;Deborah Erickson","doi":"10.1891/JDNP-2022-0012","DOIUrl":"https://doi.org/10.1891/JDNP-2022-0012","url":null,"abstract":"<p><p><b>Background:</b> Globally, cervical cancer is the fourth most common cancer in females, with more than 70% caused by the human papillomavirus (HPV) genotype 16/18. The high mortality rate could be reduced with early intervention through the administration of the HPV vaccine. <b>Objective:</b> The purpose of this project was to increase the HPV vaccination rates in the primary care setting by bundling the HPV vaccine with routine vaccines (Tdap), meningococcal, and influenza. <b>Method:</b>The electronic medical record was used to identify patients due for the HPV vaccine series. Each patient received a vaccine reminder letter detailing each vaccine recommended during the visit and their rights to accept or decline the vaccines. <b>Results:</b> Findings revealed bundling the vaccine increased the HPV vaccination rates up to 400% when compared with the previous year. <b>Conclusion:</b> This implementation process has the potential to improve the health of the population by increasing the HPV vaccination rates and decreasing the high mortality rates and costs associated with cervical cancers or precancers. <b>Implications for Nursing:</b> The evidence-based practice of bundling the HPV vaccine, educating the staff, and providing written information to the patients is recommended for advanced practical registered nurses to improve the health of the population.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adopting Urinary Tract Infection Guidelines to Promote Antibiotic Stewardship in the Time of Telehealth Medicine.","authors":"Ragan Johnson,&nbsp;Thomas N Groff,&nbsp;Vanessa M Kirkwood,&nbsp;Katie L Richardson,&nbsp;Julie A Thompson","doi":"10.1891/JDNP-2022-0026","DOIUrl":"https://doi.org/10.1891/JDNP-2022-0026","url":null,"abstract":"<p><p><b>Background:</b> The most modifiable risk factor contributing to antibiotic resistance is the inappropriate prescription of antibiotics. Urinary tract infections (UTIs) are a common outpatient infection in the United States, with increasing antimicrobial resistance to uropathogens. As empiric UTI treatment is often appropriate, telemedicine offers an opportunity to enhance practice by adopting current clinical practice guidelines. <b>Objective:</b> The project aims to improve appropriate first-line antibiotic choice and decrease urinalysis and urine culture orders in the telehealth management of uncomplicated UTIs. <b>Methods:</b> Chart reviews of women aged 18-65 years diagnosed with an uncomplicated UTI and/or symptoms during a telehealth primary care visit were conducted for a period of 30 days prior to and following a provider educational intervention. <b>Results:</b> Improvement (37.5%-62.1%, <i>p</i> = .133), though not significant, of appropriate first-line antibiotics prescribing postintervention was achieved. There was a minimal (3%) improvement in the appropriate urine labs ordered. <b>Conclusion:</b> Following the intervention, there was not a statistically significant practice change, albeit somewhat of an improvement in the ordering of first-line antibiotics. Adopting evidence-based practice in telehealth could provide an opportunity to improve antibiotic stewardship. Providers are potentially better engaged through the presence of champions, in-person education sessions, and the availability of streamlined algorithms.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stories Give Form to a Complex Reality: A Narrative Inquiry of DNP-Prepared APRNs During the COVID-19 Crisis.","authors":"Ethel Ulrich,&nbsp;Margaret Whelan,&nbsp;Elizabeth Cotter","doi":"10.1891/JDNP-2021-0007","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0007","url":null,"abstract":"<p><p><b>Background:</b> The COVID-19 pandemic changed the landscape of healthcare, yet there is a gap in the literature concerning Doctor of Nursing Practice (DNP) experiences during the COVID-19 pandemic. <b>Objective:</b> To gather an authentic understanding of the DNP-prepared Advanced Practice Registered Nurse (APRN) experiences (stories) caring for patients during the COVID-19 pandemic. <b>Methods:</b> This was a qualitative narrative inquiry study. A purposive sample of DNP-prepared APRNs (<i>n</i> = 8) was recruited to participate. All interviews were audio recorded, recordings were transcribed, and then each participant's narrative story was crafted by the authors. <b>Results:</b> Four overarching themes were identified: Do the Right Thing, Stepping Up, From Here to Reality, and Complex COVID Coping. Twelve subthemes were also identified. Participant stories were profound and indicated that their DNP education prepared them well for the healthcare crisis, but the emotional toll was difficult. <b>Conclusions/Implications for Practice:</b> This research provides insight into the experience of DNPs working during the COVID-19 crisis and elucidates the duty of nursing leaders and educators to appropriately plan, safeguard, and guide DNPs, students, and nurses at all levels. Preparation in epidemiology, public health, disaster planning, tele practice, and wellness is paramount.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10067636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of the Hand Hygiene Eczema Education Program to Improve Patient Knowledge and Symptoms.","authors":"Marina Tuller,&nbsp;Karen Arca-Contreras","doi":"10.1891/JDNP-2022-0003","DOIUrl":"https://doi.org/10.1891/JDNP-2022-0003","url":null,"abstract":"<p><p><b>Background:</b> COVID-19 hand hygiene recommendation had resulted in a hand eczema -exacerbation. The guidelines of care for the management of hand eczema recommend the use of educational interventions for patients. <b>Objective:</b> An educational intervention was designed to increase the patient's knowledge of appropriate hand hygiene and improve the patient's symptoms. <b>Methods:</b> The validated self-assessment patient-oriented eczema measure tool and pre- and post-tests were used to measure outcomes prior to educational intervention and again in 1-2 months postintervention. Of the 26 participants enrolled, 21 completed the study. The study included newly diagnosed or established patients with eczema, and the education material was available for all patients. <b>Results:</b> The difference between the average pretest and initial posttest was statistically significant (<i>df</i> = 20, <i>P</i> (<i>T</i> ≤ <i>t</i>) = 0.000663535, <i>p</i> < .05). Similarly, the difference between the average pretest and follow-up posttest was also statistically significant (<i>df</i> = 20, <i>P</i> (<i>T</i> ≤ <i>t</i>) < 0.001, <i>p</i> < .05). Participants also had a 2.04 mean point decrease in symptoms severity. <b>Conclusions:</b> The results demonstrated an improvement in patient's knowledge and reduction in symptoms. <b>Implications for Nursing:</b> The program can serve as a new guideline for managing hand eczema symptoms due to COVID-19 in the adult population in the private office setting.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9615832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unfolding Case Studies for Nursing Leadership.","authors":"Patricia Cameron,&nbsp;Cheryl Jusela","doi":"10.1891/JDNP-2021-0018","DOIUrl":"https://doi.org/10.1891/JDNP-2021-0018","url":null,"abstract":"<p><p><b>Background:</b> The education of nursing students has changed radically during the COVID-19 pandemic, with more content being delivered virtually. With less face-to-face (F2F) contact with educators, content translation to real-world scenarios is diminished. <b>Objective:</b> To determine if an educational seminar using unfolding case studies will improve students' understanding of concepts. <b>Method:</b> A pilot study of senior-level nursing students of an intensive unfolding case study application was conducted to focus on concept application. <b>Results:</b> Pre- and post-tests were compared with the increase in understanding of the focused topics, delegation, advanced directives, and safety, which was statistically significant (t[55] = 6.92, p < .001). <b>Conclusion:</b> Using real-world clinical problems through case studies facilitates understanding concepts and developing critical thinking skills/problem-solving abilities. The results of this study provide an impetus for the use of unfolding case studies to help nursing students understand leadership concepts.</p>","PeriodicalId":40310,"journal":{"name":"Journal of Doctoral Nursing Practice","volume":null,"pages":null},"PeriodicalIF":0.3,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9601235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}