Journal of Doctoral Nursing Practice最新文献

Background: Childhood obesity continues to rise globally with the potential for serious consequences to a child's physical and mental health and alarming economic impacts. In the United States, approximately one in five children is obese. The literature suggests that providing young children with foundational knowledge and skills to lead a healthier life can change the trajectory of chronic disease, improve population health outcomes, and lower health care costs across the United States. Objective: Second graders receiving a 12-lesson healthy habit program will demonstrate a 10% increase in healthy behaviors and beliefs 4 weeks postprogram completion. Method: This quality improvement (QI) initiative was delivered at three elementary schools using a consistent coach, the Healthy LifeStars Program, an evidence-based healthy habit education program that included 12 lessons and began with a mindfulness activity. Pre- and postintervention surveys were used to assess students' health behaviors and beliefs. Results: The pre- and postintervention survey scores indicated a small effect, as measured by Cohen's d, clinical significance, and an overall positive shift toward improved health behaviors and beliefs. One of the three participating school districts demonstrated a 7.5% increase in healthy behaviors 4 weeks postprogram completion. Conclusion: The QI initiative illustrates how implementing a school-based intervention can address the global health concerns of childhood obesity and increase the overall health and wellness of children. Implications for Nursing: As leaders in health, nurses are in an opportune position to lead, collaborate, and organize initiatives with interdisciplinary teams and families to promote improved health outcomes in children.

Background: The Centers for Disease Control and Prevention opioid prescribing guidelines for chronic pain were developed to combat morbidity and mortality associated with the escalating opioid crisis; however, implementing these guidelines is challenging. Clinic policies focused on treatment recommendations for chronic opioid therapy (COT) are needed to assist clinicians in safely managing pain. The purpose of this quality improvement project was to assess whether the implementation of a COT clinic policy improved provider adherence to evidence-based opioid prescribing guidelines based on state regulations in a nurse-led primary care clinic. Objectives: This project aimed to establish chronic opioid management best practices to improve provider adherence to state guidelines in a nurse-led primary care clinic. Methods: A quasi-experimental pre-post-intervention design was utilized with a sample of five providers and 33 COT patients. Results: Paired-sample t tests were used to assess the effect of COT policy implementation. Overall, no statistically significant differences were noted; however, policy implementation resulted in improved documentation of six key COT measures. Medium effect sizes were observed for completed opioid contracts (Cohen's d = .43), utilization of nonopioid pain therapies (d = .36), and urine drug screens (d = .39), indicating a moderate impact of the intervention in these areas. Conclusions: The findings suggest that education and implementation of a clinic opioid policy in primary care practice are effective in meeting evidence-based practice guidelines for COT. The importance of broad stakeholder engagement and ongoing support for policy adoption was highlighted. Nursing Implications: This project provides valuable insights into improving the safety of pain management in primary care to improve prescribing practices and mitigate risks associated with COT.

Background: Access to manual uterine aspiration (MUA) training in the United States is precarious and fraught. WhatsApp, the instant messaging platform, is used in medical education and peer collaboration. Advanced registered nurse practitioners (ARNPs) lack sufficient access to mentorship for learning MUA. Objective: This pilot study examines the effect of participation in a WhatsApp Mentorship Group on perceived mentorship for ARNPs learning MUA. Methods: Study design was quasi-experimental. ARNPs attending a reproductive health conference completed a survey measuring mentorship. Participants were invited to join the WhatsApp Mentorship Group. Within the group, mentors posted predetermined questions biweekly to stimulate conversation, answer clinical practice questions, and provide access to educational media files. Results: Following participation in the WhatsApp Mentorship Group, mean informational support levels increased by a statistically significant 5% (p =03). Conclusion: WhatsApp may be a viable option for expanding mentorship among ARNPs. Implications for Nursing: ARNPs may benefit from further inquiry into the use of WhatsApp for mentorship, including fellowships. Engagement data from this study suggest a bimodal level of mentorship perception.

Background: Obesity is a prevalent chronic disease associated with many comorbidities and increased mortality rates. Primary care providers are critical in addressing obesity through an evidence-based weight loss protocol. Objective: This Doctor of Nurse Practice project aimed to develop and implement a standardized, evidence-based holistic weight loss protocol, incorporating glucagon-like peptide-1 (GLP-1) medication, semaglutide, and motivational interviewing within a patient-centered framework. Methods: In this quality improvement project, 10 nondiabetic participants with a body mass index (BMI) ≥ 27 kg/m² were recruited from a suburban clinic in Cypress, TX. Data such as body weight, BMI, and blood pressure were collected in addition to Impact of Weight on Quality of Life-Lite (IWQOL-lite) survey responses. Data were then analyzed in Excel using the paired t test with statistical significance being <.05. Results: Participants lost a significant amount of weight (p < .05) and had a significant decrease in BMI (p < .05). Postintervention physical function, self-esteem, and work-related experiences improved significantly (p < .05) based on the IWQOL questionnaire pre- and postintervention. Diastolic blood pressure also significantly decreased (p < .05). Conclusions: This weight loss protocol, guided by evidence-based practice alongside GLP-1 medication, semaglutide, revealed positive outcomes in weight reduction, BMI, and quality of life. This protocol offers providers a promising approach to managing obesity in primary care settings. Implications for Nursing: Implementing this evidence-based weight loss protocol can empower advanced practice nurses (APRNs) to address obesity effectively. Motivational interviewing, holistic patient-centered care, ongoing support, and education are critical features to sustaining weight loss for obese patients. This protocol provides a structured approach for APRNs in guiding nondiabetic overweight and obese patients toward sustainable weight loss.

Background: Excessive generation of clinical alarms can result in ignored alarms and staff alarm fatigue putting patient safety at risk. A retrospective chart review reported an average of 19.44 alarms/patient/hour were generated on two 26-bed acute care units. Evidence supported implementing an alarm bundle. Objectives: This quality improvement project aimed to implement an evidence-based bundle to reduce the number of nonactionable telemetry alarms occurring on two adult acute care inpatient units in a large community hospital. Methods: Weekly audits were used to assess workflow adherence. Run charts were used to show process adherence from audit findings. Results: Adherence to daily electrode sticker changes was 80% (n = 118) and 75% (n = 110) for electronic medical record (EMR) documentation. Error with Lead V sticker placement occurred at 34% (n = 50) frequency. Once, a shift parameter documentation was 75% (n = 194) and 86% (n = 117) for customized parameter documentation. Frequency of nurse-driven heart rate parameter customization was 17% (n = 44). Adherence to the use of standby was 75% (n = 166). Conclusions: Safe clinical judgment was used in customizing parameters for patients experiencing heart rate significantly above or below parameter threshold. Implications for Nursing: An evidence-based alarm bundle can be introduced safely and reduces nonactionable alarms in the adult acute care setting.

Background: When nurse practitioner students start clinical rotations, they may feel unprepared to present patient case information to their preceptors. Although preceptors understand the benefits of active learning, when students provide weak or tangential presentations from lack of a structured model, preceptors may fall back on observational and passive learning due to time management constraints. Objective: This article shows an example of teaching SNAPPS during an on-campus skills lab and the outcomes for students and faculty. Methods: Students were taught the SNAPPS model during a skills lab in advanced health assessment. Utilizing case studies in a role-play format, they practiced acquired course skills and presented patient information using SNAPPS. The students completed surveys both before and after the skills lab. A Likert scale was used to measure their confidence levels at both points of time. Results: A Wilcoxon signed-rank test revealed a statistically significant increase in student confidence across all postsurvey scores (p < .05). Conclusion: Interactive case studies with SNAPPS practice enhance student confidence prior to clinical rotations. Implications for Nursing: As an active learning model, SNAPPS may ease the burden on preceptors and make them more receptive to having students.

Background: Hyperphosphatemia is a modifiable risk factor for cardiovascular morbidity and mortality in patients on hemodialysis. However, despite efforts to control hyperphosphatemia, it remains a prevalent issue among adult patients on maintenance hemodialysis worldwide. Objectives: An intensive multidisciplinary educational program focusing on diet control and medication compliance was developed to lower the incidence rate of hyperphosphatemia and serum phosphorus levels among adult patients on hemodialysis and to improve their understanding of hyperphosphatemia control. The objectives were to decrease the incidence rate of hyperphosphatemia and the mean phosphorus level among participants by 10% and to improve their knowledge assessment scores by 30% within 3 months. Methods: The education program was implemented at a hemodialysis clinic serving adult end-stage renal disease patients. Education was delivered via videos, pamphlets, and bimonthly one-on-one follow-up sessions. The incidence rate of hyperphosphatemia, mean serum phosphorus levels, and knowledge assessment scores were measured before and after the intervention. Descriptive and comparison statistics were used in data analysis. Results: Following the intervention, the incidence rate of hyperphosphatemia decreased by 45% within the intervention group and by 18% across the entire dialysis clinic. The mean serum phosphorus level within the intervention group decreased by 16% after intervention (p = .007). Additionally, the intervention group showed a statistically significant improvement in knowledge assessment test scores (p = .018). Conclusion: The intensive multidisciplinary education program effectively educated patients with hyperphosphatemia about phosphorus control, reduced the incidence rate of hyperphosphatemia, and helped lower serum phosphorus levels to within a normal range. Implications for Nursing Practice: Advanced practice registered nurses can play an important role in improving patient outcomes and management of hyperphosphatemia.

Background: People with newly acquired hepatitis C virus (HCV) infections are usually asymptomatic and unaware of the disease. Approximately 70%-85% of people infected with the virus develop a chronic infection causing severe long-term health problems. The incidence rate of hepatitis C infections in Kern County is higher than the State of California's overall rate. In Kern County, a 31% increase in the incidence rate of HCV infections occurred from 2014 to 2018 compared with a 3% increase in California. Objective: This study aimed to improve HCV screening rates in patients 18-79 years old at a family practice clinic. Methods: A descriptive practice change design used a retrospective and prospective method to compare HCV screening rates pre- and postintervention of an office policy implementation combined with provider education. Results: In 400 patients in the age group of 18-79 years treated at the clinic in October 2020, 4 weeks before the policy change project implementation, 1.0% of the cohort was screened for HCV. In the postintervention period, 30% of the 44 eligible patients were screened. The increase in the percentage of the cohort screened from 1.0% to 29% was significant (χ² [df = 1] = 87.719, p < .001). Conclusion: The education of the health care team to ensure buy-in and understanding of the clinical practice change and the development and implementation of a new screening policy yielded an enhanced HCV screening rate at this family practice clinic. Implications for Nursing: Advance practice registered nurses (APRNs) can significantly participate in the reduction of poor health outcomes related to chronic HCV infection by consistently screening all qualified patients between the ages of 18 and 79 years by 2030. APRNs can join the call to action by providing HCV screening services at a local level.

Background: Nurse practitioners are well positioned to promote health and improve health outcomes of individuals. Those who receive additional education in population health leadership are further prepared to lead efforts to improve population health outcomes. Objective: The purpose of this paper is to describe a 28-month, part-time post-Master of Science in Nursing (MSN) population health Doctor of Nursing Practice program designed for nurse practitioners and highlight project exemplars that demonstrate the integration of population health into advanced nursing practice. Methods: The program is thoroughly described, including alignment with the Council of Public Health Nursing Organizations (CPHNO) competency domains. To demonstrate the application of population health competencies into advanced practice nursing, project summaries from 2012 to 2020 were reviewed. Results: The program review showed clear alignment between major assignments and CPHNO competency domains. Fifty-one project summaries were reviewed. Authors present select project exemplars that highlight various ways students incorporated population health into their projects. Conclusions: To lead efforts to promote population health across the care continuum, nurse practitioners must have advanced knowledge and skills to address factors that influence the health of the populations they serve. Implications for Nursing: Nurse educators must design, implement, and evaluate strategies to prepare nurse practitioners to integrate population health into practice.

Background: Females with bleeding disorders benefit from management to control heavy menstruation. Multidisciplinary pediatric menstrual bleeding disorder clinics offer a wide range of beneficial services; however, not enough data exist regarding the use of structured management pathways to deliver positive patient outcomes. Objective: Identify evidence-based interventions and develop a clinical pathway for providers of a multidisciplinary pediatric menstrual bleeding disorder clinic, including assessment of patients' baseline and postvisit knowledge of treatment options, reportable symptoms, and provider pathway satisfaction. Methods: A structured management pathway and educational treatment forms were developed and implemented in the clinic. Female participants experiencing heavy menstruation completed knowledge questionnaires before/after clinic visit with health care providers during which educational handouts were reviewed. Providers completed satisfaction surveys following patient visits. Results: Nine participants completed pre/postvisit knowledge questionnaires with statistically significant improvement in knowledge (p = .03). Providers expressed overall satisfaction with pathway and educational materials with overall mean satisfaction Likert scale scores >4 of 5. Conclusions: Multidisciplinary clinics can improve patient care. Benefits of such structures continue to guide evidence-based practice and are important to maintain patient-centered care. Implications for Nursing: Integrating standardized practices through a clinical pathway and formal educational materials increases patient knowledge and provider satisfaction.