Journal of Doctoral Nursing Practice最新文献

Introduction/Purpose: 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). Methods: 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 N = 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%). Results: Paired t tests were used to determine significant changes in BMI and A1c parameters pre- and postintervention. Preintervention A1c (M = 9.5, SD = 1.7) and BMI (M = 33.2, SD = 7.8) and postintervention A1c (M = 7.8, SD = 1.5) and BMI (M = 32.2, SD = 7.9) indicate that DSMES significantly reduced A1c, t(53) = 8.1, p = <.001, and BMI, t(53) = 4.4, p = <.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 (B = .41, p = .01, R² = .96) and postmeasure of A1c (B = .28, p = .04, R² =.41). Discussion: 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.

Background: 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. Objective: A quality improvement project with an evidence-based standard of care for PPD screening was implemented with every postpartum patient. Methods: 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. Results: 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%. Conclusion: 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. Implications for Nursing: 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.

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Background: 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. Objective: 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. Method: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. Results: Findings revealed bundling the vaccine increased the HPV vaccination rates up to 400% when compared with the previous year. Conclusion: 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. Implications for Nursing: 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.

Background: 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. Objective: The project aims to improve appropriate first-line antibiotic choice and decrease urinalysis and urine culture orders in the telehealth management of uncomplicated UTIs. Methods: 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. Results: Improvement (37.5%-62.1%, p = .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. Conclusion: 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.

Background: 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. Objective: To gather an authentic understanding of the DNP-prepared Advanced Practice Registered Nurse (APRN) experiences (stories) caring for patients during the COVID-19 pandemic. Methods: This was a qualitative narrative inquiry study. A purposive sample of DNP-prepared APRNs (n = 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. Results: 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. Conclusions/Implications for Practice: 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.

Background: 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. Objective: To determine if an educational seminar using unfolding case studies will improve students' understanding of concepts. Method: A pilot study of senior-level nursing students of an intensive unfolding case study application was conducted to focus on concept application. Results: 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). Conclusion: 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.

Background: 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. Objective: An educational intervention was designed to increase the patient's knowledge of appropriate hand hygiene and improve the patient's symptoms. Methods: 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. Results: The difference between the average pretest and initial posttest was statistically significant (df = 20, P (T ≤ t) = 0.000663535, p < .05). Similarly, the difference between the average pretest and follow-up posttest was also statistically significant (df = 20, P (T ≤ t) < 0.001, p < .05). Participants also had a 2.04 mean point decrease in symptoms severity. Conclusions: The results demonstrated an improvement in patient's knowledge and reduction in symptoms. Implications for Nursing: 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.

Background: Innovative strategies are crucial for addressing essential faculty knowledge for teaching and advising Doctor of Nursing Practice (DNP) students, especially during the phase of time-sensitive scholarly projects. Challenges of diverse educational and experiential background of faculty may contribute to inconsistent student advisement and learning. Lack of clear expectations creates barriers to student learning. Methods: Published reports and faculty input were used to develop evaluation tools utilized in DNP project courses. The tools allowed for clear expectations of faculty instruction and advising, student work, and fostered student growth. Results: Rubrics developed for DNP project courses facilitated diverse student learning needs. Evaluation tools, informed by national guidelines, were developed to guide DNP faculty and student success, resulting in consistent evaluation of student scholarly work and attainment of the DNP Essentials Conclusions: Student evaluation tools that reflected the national guidelines facilitated student learning and assisted faculty instruction and advising. These rubrics have positioned our college for the transition to competency-based doctoral education. Implications for Nursing: The tools shared in this article could be adapted to fit other DNP programs aligning critical elements of students' attainment of knowledge, skills, and abilities of the DNP degree in the move toward competency-based education in the newly revised Essentials (2021).

Background: Transgender people often experience social exclusion and transphobic attitudes, which have an adverse impact on their socioeconomic life and health status. Within health services, -discriminatory practices and mistreatment derive from the lack of cultural competence by -healthcare providers. Objective: This article features existing barriers in the provision of healthcare to transgender populations and suggests approaches to manage the relevant challenges. Methods: A thorough review of the literature was performed, and the operation of a specialized unit wass presented. Results: Health professionals are often unskilled or unwilling to offer transgender care, while most healthcare service institutions do not offer specialized treatments. Incomplete health insurance coverage and shortages of personal income impede trans individuals' access to healthcare. Certain practices and policies are needed for scientifically and culturally competent services. Conclusions: The social vulnerability and the unique health needs of transgender persons urgently call for accessible and effective care for gender minority individuals. The integration of gender identity issues into continuous medical and nursing education is a key component of transgender-friendly care. Implications for Nursing: The integration of diversity as a core value in health services, the ability of health personnel to deliver transgender care, and the provision of insurance coverage solely based on medical needs are necessary steps to achieve social justice in healthcare.