On Thursday, April 16, 2015 the twelve Doctor of Nursing Practice students presented their final projects following a presentation by the Distinguished Roy & Fay Whitney Lecturer, Dr. Jean Watson. Watson spoke on "Caring Science: Disciplinary Foundation for Nursing."
The students and their project abstracts are linked below.
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Project title: System Improvement for Age and Gender-Appropriate Health Screening Practices
Abstract:
Background: The United States Preventative Services Task Force (USPSTF) generates evidence-based
preventive health screening recommendations for the general adult population, yet
recommendation adherence is often unknown or not assessed by primary care providers.
Aim: This mixed methods study will evaluate a system level improvement at a free primary
care clinic. The goal is to utilize non-provider personnel to assess client preventive
health screening history, identify needs and to disseminate age and gender specific
information regarding routine health screening recommendations.
Method: Participants are volunteers at a local free clinic working in clinic intake, ranging
from trained medical personnel to lay people. Participants utilize a form to evaluate
what USPSTF screening tests clients have completed and provide information about how
to complete necessary screening. Participants are asked about ease in using the screening
tool and feasibility of completing the task. Changes are then made to the form and
process based upon feedback. Quantitative data are collected from each assessment
form to determine if appropriate screening history was collected and information provided.
Results: Preliminary data indicate the main barrier to implementation is perceived lack of
time to complete assessment. To date, 19 of 45 clients have been assessed and 18 of
19 forms were completed accurately.
Conclusion: Implementation of the system improvement will result in more complete healthcare
provided to clients through assessing and recommending routine preventive health screening.
Implications for other clinics will be to utilize non-provider personnel in innovative
ways to ease provider burden for assessing routine health screening needs.
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Project title: Project title: Effect of Behavior Counseling on Weight Loss in Primary Care
Abstract:
Background: Behavior therapy can be effective in promoting weight loss in individuals who are
overweight or obese. However, little evidence exists regarding the effect of nurse
practitioner-guided behavior change programs on weight loss in individuals in a primary
care setting.
Purpose: The objective of this study is to identify the effect of behavior change counseling
techniques such as motivational interviewing, goal setting, self-monitoring, and perceived
self-efficacy on weight loss in adult clients within primary care.
Methods: Three established clients at a low-income primary care clinic in Laramie, Wyoming
are currently enrolled in six 30-minute weight loss counseling sessions led by a Doctor
of Nursing Practice Family Nurse Practitioner student. Adults are eligible to participate
if: (a) they are over the age of 18; (b) have a body mass index ≥ 25; and (c) are
able to speak, read, write, and understand English. Participants’ weights are obtained
during each encounter and trends will be evaluated at the end of the study. Additional
data are being collected using questionnaires, face-to-face interviews, self-efficacy
scales, and self-monitoring results to analyze participants’ weight loss goals, previous
attempts with weight control, and perceived barriers to losing weight.
Results: Research is in progress and results will be included in the presentation.
Conclusion: It is expected that evidence from this study will identify whether nurse practitioner-guided
behavior change counseling is an effective technique for promoting weight reduction
in adult clients within primary care.
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Project title: A Review of Factors Contributing to Successful Shared Medical Appointments for Patients with Type 2 Diabetes
Abstract:
Background: Type 2 diabetes mellitus (T2DM) is a prevalent and costly disease in the United States.
Research has shown that shared medical appointments (SMAs) can improve glycemic values
and other health measurements for patients who have T2DM by encouraging lifestyle
modifications and self-management skills.
Purpose: The study purpose is to conduct an integrative review of the literature in order
to evaluate the factors involved in successful SMAs to formulate a model for future
SMAs for patients with T2DM.
Methods: Searches for articles regarding SMAs and T2DM published after 2009 on PubMed, MEDLINE,
Cochrane Library, and the University of Wyoming Libraries search engines was conducted
by the principal investigator. Articles showing glycemic control improvement were
chosen and factors of size of group, setting, title and number of providers at meeting,
duration of meetings, number of meetings, and how often meetings were held were examined
to formulate a model of a successful SMA.
Results: Preliminary analysis shows an optimal SMA would include <12 patients, in a clinic
with multiple providers of different professions attending each meeting for six to
twelve weeks.
Conclusions: It is expected that the review results can be used to assist providers in structuring
optimal setting, size, and staff for a successful SMA.
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Project title: Understanding Patient Perception and Risk for Hepatitis C Screening
Abstract:
Purpose & Background: The objectives are to examine reasons that adults do not want to test for Hepatitis
C Viral (HCV) infections and to increase awareness of risk factors and HCV infection.
The specific aims are to identify detailed themes and barriers to HCV testing and
to determine if testing rates increase when patients self-identify their risk factors
and are offered testing. HCV infections pose a significant burden on individual and
community health. The Baby Boomer (1945-1965) generation and underserved populations
continue to carry the brunt of diagnosed and undiagnosed HCV infections. Providing
information about HCV, risk, and offering screening at a Federally Qualified Health
Center (FQHC) has the potential to reach these populations.
Methods: This descriptive study uses survey and group-level electronic health record (EHR)
data. Adults that speak and write in English or Spanish arriving for care at a FQHC
in the Mountain West are being recruited to complete a survey. Descriptive statistics
will summarize demographics and responses from the survey. Descriptive analysis will
include frequency distribution, measures of central tendency, and measures of dispersion.
Zero-order correlations will assess associations between risks and reasons for not
testing. A comparison analysis of 2014 monthly testing averages compared against survey
period testing average will be done to determine if HCV screening has increased during
the survey timeframe.
Conclusions: At study completion, beginning evidence regarding risk perceptions, barrier to testing
themes, and rates of HCV testing will be revealed.
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Project title: Factors in the Initiation and Longevity of Breastfeeding in Adolescent Mothers
Abstract:
Purpose: The project purpose is to conduct a systematic review of available research on factors
affecting breastfeeding in adolescent mothers. Specifically, this systematic review
will evaluate factors supporting the decision of adolescent mothers to initiate breastfeeding,
and factors supporting their longevity and success of breastfeeding.
Background: Breastfeeding is recognized as the optimal form of nutrition for infants and promoted
by many professional health organizations. Due to the importance of breastfeeding
on the overall health and development of infants and the health benefits for mothers
it is necessary to identify ways to increase breastfeeding initiation and duration
with adolescent mothers. The breastfeeding rate of adolescent mothers is significantly
less than those 20 years of age and older.
Methods: Systematic reviews published between January 2000 and December 2014 were identified
through an electronic database search utilizing the following databases: CINAHL, PubMed,
Cochrane, and Medline ProQuest. The database search yielded 11 systematic reviews,
six were found eligible for inclusion.
Results: Study findings were categorized into 7 supporting factors: generalized emotional,
esteem, and social network support, mother and partner of the adolescent mother support,
expert lactation support, adolescent specific breastfeeding education, early RN support,
school-based programs, and preconception care.
Conclusions: Interventions need to be multi-faceted programs incorporating emotional, esteem,
and social network support. Experts need to be skilled in lactation support and teaching
adolescents. Nurse support and the mothers and partners of adolescents play significant
role in initiation and duration of breastfeeding. More research in this area is needed.
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Project title: The Role of Obesity on Chronic Kidney Disease in Primary Care: An Integrative Review
Abstract:
Background/Purpose: Obesity is a primary and independent risk factor for the development of chronic kidney
disease (CKD). The purpose of this integrative literature review is to examine research
related to obesity and CKD development and discuss implications concerning to primary
care practice.
Methods: Primary studies, review articles, and clinical practice guidelines were analyzed
independently and in duplicate using an electronic database. PubMed, CINAHL, MEDLINE,
and The Cochrane Library were searched separately using identical search criteria.
Studies and articles to be analyzed were published within the past five years- January
1, 2009 through December 31, 2014. Study participants must be 18 years or older,
obese (body mass index greater than 30), and in any stage of CKD.
Results: Preliminary results included nine randomized trials and/or observational studies
(8,772 participants) that examined the effect of weight loss on kidney function in
adults with CKD. Studies consistently demonstrate kidney function improvement with
decreased BMI, independent of weight loss method.
Conclusion: The literature review has important implications for primary care providers. Decreasing
the severity of obesity greatly improves CKD outcomes in the primary care setting.
Obesity and CKD related complications threaten to impact the nation’s health and strain
healthcare spending unless providers recognize and effectively intervene in these
co-morbid conditions increases. The link between these disease processes has significant
implications for primary care practice.
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Project title: Depression Screening in Primary Care and Impact on Suicide Prevention
Abstract:
Background: Suicide is a significant public health concern and primary care providers (PCPs)
are an important part of the national strategy for reducing suicide rates. Current
recommendations from the United States Preventative Services Task Force (USPSTF) state
that depression screening in primary care is only beneficial if mental health resources
are available to assist with management. However, there is no guidance for PCPs who
lack mental health resources, such as in rural or underserved areas.
Purpose: The project purpose is to conduct an integrative literature review on depression
screening in primary care. The review will explore the impact availability and utilization
of support services has on screening and ascertain what factors prompt PCPs to screen
for depression.
Methods: Databases include CINAHL with full text, PubMed, the Cochrane Library, and PsycInfo.
Any studies focusing on factors associated with depression screening, provider attitudes
about barriers and facilitators of screening, availability and use of support resources,
or rates of screening in primary care and published in English will be included.
Results: Study is ongoing at present and results will be available for the poster.
Conclusions: It is expected that the study will bring awareness to the importance of depression
screening and management in primary care and the need for adaptation of support services
for rural or underserved area.
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Project title: Physical Activity in the Treatment and Prevention of Depression in Adolescents
Abstract:
Background: Depression in adolescents is a major public health concern with approximately 11%
of adolescents being diagnosed with depression before the age of 18. Depression can
have a significant impact on the quality of life for adolescents in terms of comorbidities,
complications, and somatic manifestations. Treatment of depression in adolescents
can be expensive and adherence can be poor. Physical activity is a low cost, low side
effect option for patients and parents looking for alternative treatment options,
thus the purpose of this integrative literature review was to identify the role physical
activity plays in the treatment and prevention of depression to prevent more cases
of depression and associated adverse effects.
Methods: Journal articles, original research, and reviews from the last 10 years came from
in-depth searches from the following data bases: PUBMED, CINHAL, PychInfo, Cochrane,
and EBSCOHOST.
Results: A total of 68 publications were initially identified and 13 studies met the inclusion
criteria. The studies demonstrated an inverse relationship between physical activity
and depression in adolescents. However, the significance of the relationship varied
depending on confounding factors. Thus the exact role of physical activity remains
unknown.
Conclusion: Few randomized control studies have been completed on the effects of physical activity
and the treatment and prevention of depression in adolescents. The studies indicate
that physical activity can help in the treatment of depression and with overall psychological
and social health. Randomized control studies are needed to help determine the role
physical activity and/or sports participation has in adolescent depression.
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Project title: Observational Outcomes of a Multicomponent Diabetes Management Program in Inmates
Abstract:
Background: Diabetes mellitus is a chronic medical condition placing significant financial burden
on the prison healthcare system. Changing demographics in prisons have challenged
facilities to develop innovative disease management approaches to enhance outcomes
while decreasing expenditures. Programs focused on self-management strategies have
demonstrated efficacy through enhanced glycemic control, prevention of adverse outcomes,
and reductions in associated healthcare costs.
Purpose: This study aims to analyze one prison’s approach to diabetes management by examining
qualitative data regarding observed health outcomes. The program incorporates diabetes
education, nutritional counseling, self-monitoring techniques, lifestyle modification,
and incentives for active participation to encourage an active role in health and
wellness.
Methods: Data were collected through personal interviews with members of the healthcare team
overseeing those inmates participating in the program. A standard questionnaire was
utilized to evaluate staff’s perceptions and observed outcomes associated with this
approach. Data collected are being examined using content analysis to assess for trends
or variations in participant responses, allowing for inferences to be made regarding
program efficacy.
Results: Data analysis is ongoing; however, preliminary analyses indicate positive health
outcomes associated with the described approach. Staff report direct benefits including
enhanced glycemic control, weight loss, and reductions in pharmacotherapy requirements
resulting in decreased financial burden. Indirect benefits include improved inmate
behavior, increased self-esteem, and enhanced inmate confidence regarding their abilities
to self-manage.
Conclusions: Final results and conclusions will be available at the time of presentation and should
provide additional insight into the efficacy and potential implications of this approach
to diabetes management.
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Project title: Enhancing Childbirth Satisfaction through a Brief, Targeted Education Intervention
Abstract:
Background: A woman’s experience during childbirth should be positive and meaningful, yet a large
body of literature reports maternal dissatisfaction with labor and childbirth experiences.
Purpose: The purpose of this descriptive, comparative study is to explore the effects of a
brief, targeted educational intervention on childbirth satisfaction, using a family
medicine setting. The aims of this project are to: test the feasibility of implementing
a brief (1/2 hour), targeted educational intervention with women in their 3rd trimester
of pregnancy as an added service to a routinely scheduled office visit; compare postpartum
childbirth satisfaction (two weeks postpartum) of obstetrical patients who receive
the brief, targeted educational session in their third trimester of care to a group
of similar patients who receive routine obstetrical care.
Participants: Pregnant women (a) in their third trimester of pregnancy (b) have not taken childbirth
preparation classes during this pregnancy, (c) not receiving additional specialty
care because of high risk, (d) 18-34 years old, (e) first time or previous pregnancy,
and (f) able to understand and read English. Intervention group (n=>10), comparison
group (n=10).
Methods: Participants for the intervention group will receive a brief, targeted education
session in their third trimester of pregnancy and complete a childbirth satisfaction
survey at two weeks postpartum. Participants for the comparison group (usual care
only) will only complete a childbirth satisfaction survey at two weeks postpartum.
Analysis will be descriptive statistics and t-tests.
Results: Findings will be reported in the presentation.
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