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2016 DNP Graduating Class present research projects:
On Friday, April 15, 2016, the ten Doctor of Nursing Practice students will present their poster presentations at the Health Sciences Grand Rounds, 2nd floor of the Wyoming Student Union. Posters are available for viewing at 8:30 a.m; 10 a.m.; and 3 p.m., with awards presentation following.
On Thursday, April 14, 2016 the ten Doctor of Nursing Practice students presented their final projects followed by a presentation by the Distinguished Roy & Fay Whitney Lecturer, Dr. Susan Luparell. Luparell spoke on "Cultivating Civility in Nursing: A Call to Arms."
The students and their project abstracts subjects are listed below. Following the pictures and project titles, find the full text of the actuall abstracts.
Michelle DowlingProject title:
An Initial Investigation into Developing Nurse Practitioner Residencies in Wyoming’s Federally Qualified Health Center Network
Abstracts for DNP Candidate Project Presentations
Aaron Wright & Teresa Thompson
Project title: System Improvement for Depression Screening
Introduction/Purpose: Depression is a widespread problem that is predicted to become more prevalent. Despite depression being one of the leading disease burdens in the United States, depression screening and treatment are often overlooked in the primary care setting. One way to increase screening rates is to embed depression-screening tools into an Electronic Health Record (EHR). Our project provided primary care providers with an EHR embedded screening tool for depression and assessed if the embedded tool is effective at identifying patients who suffer from depression in a primary care setting.
Methodology: This study setting was a metropolitan, title X primary care clinic that mainly serves patients of lower economic status. This clinic typically is staffed with a medical assistant (MA), one to two nurse practitioners (NPs), and a receptionist/biller. Patient demographics include males and females, as well as age groups encompassing adolescent up to geriatric. From December 2015 through March 2016, a depression screening tool was embedded into an EHR. Patients were assessed with the PHQ-2 depression-screening questions by an NP. The NP evaluated the PHQ-2 score and determined if the PHQ-9 needed to be used for further screening. A PHQ-2 was considered positive with a score of 3 or greater. When a positive PHQ-2 was assessed, the PHQ-9 was administered. A PHQ-9 was considered positive with a score of 9 or greater. When a positive PHQ-9 was assessed, the NP offered interventional treatment and follow-up care. All obtained information, including screening scores, interventions, and referrals were recorded into the EHR. The NPs had a list of mental health providers available in the community to make referrals as needed. Also, an algorithm based on current and evidence-based interventions was available to each NP for use when patients tested positive on the PHQ-9.
Results: Preliminary results indicated that PHQ-2 and PHQ-9 questions can be effectively used to screen for depression in primary care when implemented into the EHR.
Project title: Interprofessional Collaboration: Improving Relationships between Nurse Practitioners and Physicians
Introduction: Research supports improved patient satisfaction and outcomes with a team approach to healthcare. The National Academy of Medicine (NAM), previously known as the Institute of Medicine (IOM), has called for a change in graduate level education to include an interprofessional component. Collaborative care can positively impact patient care, employee satisfaction, and help disperse the workload across the team. Teamwork in the healthcare setting promotes autonomy and respect, improves productivity, reduces job strain, and improves strategic alliances. Successful collaboration between physicians and nurse practitioners (NPs) is crucial to improving patient outcomes. To answer the NAM’s call for interprofessional education, more research is needed about interprofessional curriculum and approaches to implementing it. This descriptive study had a dual purpose: 1) to determine what attributes make a successful collaborative NP and physician team and 2) to synthesize ideas for interdisciplinary education for NP and medical students, particularly in rural Wyoming. By conducting interviews with collaborating teams of NPs and physicians, a deeper understanding of team dynamics and how interprofessional relationships develop can be gained. These data can be used to propose specific interdisciplinary education curriculum concepts to graduate level programs across the country, particularly in rural Wyoming.
Methodology: After receiving approval from the Institutional Review Board at the University of Wyoming, a convenience sample of collaborating pairs of NPs and physicians was asked to participate in a fifteen to thirty-minute interview to discuss their collaborative relationship, interprofessional education, and ideas of how to incorporate interprofessional collaboration into graduate level education. As this was a convenience sample, collaborating pairs of physicians and NPs in areas other than primary care were included. A short introduction to the purpose of the research was given to both providers; a list of questions was used as a guide for each interview; however, these interviews were informal, allowing the providers to speak freely. The data were analyzed using Content Analysis.
Results: Six collaborating pairs of nurse practitioners and physicians were interviewed. After data are fully analyzed, trends will be presented.
Discussion: Discussion will be based on analyzed data.
Implications: Implications for future practice will also be based on interview data.
Project title: System Improvement for Age and Gender-Appropriate Health Screening Practices
Introduction/Purpose: Health screenings are an important part of today’s health care. Health screenings have been shown to reduce deaths from or related to colorectal cancer by 60%, breast cancer by 20-25%, and cervical cancer by 20-60%. Among other chronic diseases, screening enables early diagnosis, which helps reduce disease-associated morbidity. The United States Preventive Service Task Force (USPSTF) is an independent group of experts in disease prevention that outlines best practice screening guidelines based on age and gender. These guidelines are developed from research and then distributed widely to help clinicians and clients know which health screenings are recommended for specific ages and genders in order to identify, prevent, and/or treat chronic illness and prevent premature deaths. Clinicians and non-healthcare personnel can reduce the morbidity and mortality associated with different diseases and cancers by appropriately screening clients based on USPSTF recommendations. Health screenings are often difficult for clinicians to address during acute visits due to lack of time, and therefore are frequently skipped. Studies have shown that non-healthcare personnel are often capable of completing health screenings, based on the recommendations from USPSTF. The purpose of the project was to develop and refine a procedure to increase the number of clients receiving health-screening information at a free clinic, utilizing non-healthcare volunteers. The anticipated result is a successful implementation of a screening process that leads to increased prevention of chronic diseases and early detection of cancer, reducing associated mortality and morbidity.
Methodology: Based on the recommendation from USPSTF every client who presented to the clinic was assessed and advised regarding recommended screenings according to their age and gender. The project used Plan-Do-Study-Act (PDSA) cycles during the implementation process to help identify and overcome barriers associated with the new process. Non-healthcare volunteers met with clients to assess and advise them regarding recommended screenings. After each clinic session, volunteers who agreed to participate in the study completed an open-ended questionnaire on what was going well with the process, what needs to be changed, and how the process could be improved. Based upon participant feedback, the project investigator worked with the non-healthcare volunteers and the director of the clinic to make changes to the process, improving the effectiveness of the important screening process.
Results: Results will be presented at the podium presentation.
Discussion: Discussion will stem from the study results and be presented.
Implications: Implications for future practice will also stem from results of the study.
Project title: Polycystic Ovary Syndrome: What Do Nurse Practitioners Know?
Introduction: Polycystic ovary syndrome (PCOS) is a clinical condition that manifests itself through
symptoms including hirsutism, acne, hyperinsulinemia, obesity, menstrual irregularities,
and infertility. In addition to bothersome symptoms, the long-term complications and
consequences of PCOS can lead to psychological conditions such as depression and anxiety,
cardiovascular conditions such as dyslipidemia and hypertension, and metabolic conditions
including type 2 diabetes mellitus.
Purpose: Nurse practitioners (NP) must understand not only the symptomatic attributes of PCOS, but the keys to diagnosing and treating this long-term, chronic condition. Therefore, the study purpose was to: (a) assess NP baseline knowledge of PCOS for assessment, diagnosis, and management of the disease; and (b) assess if a short continuing education seminar on PCOS was an effective educational approach to increasing NP’s knowledge about assessing, diagnosing and managing PCOS in the clinical setting.
Methods: To address the study objective, a brief educational seminar about PCOS was conducted at a regional NP conference. A pre- and post- test questionnaire was given to seminar participants to assess their knowledge of PCOS before and after the seminar. Responses to the questionnaires were entered into SPSS Version 22 and checked for errors. Survey responses were tabulated to determine NPs knowledge of specific components of PCOS both pre- and post- seminar. MANOVA was used to identify significant difference between pre- and post- testing data. Follow-up T-tests determined whether there is a significant increase in knowledge from pre- to post-test at p < = .05.
Results: Final results will be given at the oral presentation.
Discussion: Polycystic ovarian syndrome affects upwards of 20% of women of reproductive age and can present as a challenging diagnosis to healthcare providers. As more and more NPs are stepping into the role of primary care healthcare providers, they are on the forefront to diagnosing this troubling condition. By encouraging NP educational programs to include curriculum on PCOS, women with this hyperandronergic condition can be recognized early in their disease course by NPs and have the potential to halt the long-term consequences of PCOS.
Implications: The study results will provide beginning evidence to guide NP education regarding PCOS.
Sara B. Jackman and Brandon N. Bennion (Shared Presentation)
Project title: Benefits and Downfalls of Scope of Practice Laws on the Quality of CareProvided by Nurse Practitioners
Introduction: There are consistent challenges facing healthcare, namely, how to provide high quality,
affordable healthcare to the greatest number of patients. One potential method of
addressing this need would be to expand scope of practice laws for nurse practitioners
increasing the number of patients who can receive quality care.
Purpose: The a.m. of this systematic review was to analyze how state specific nurse practitioner (NP) scope of practice laws (SOPL) affect cost and quality of primary care to individuals within those states. This systematic review was established to clarify Hooker and Muchow’s (2015) hypothesis that expanding scope of practice laws for NPs would result in an influx of NP professionals who would provide primary care to a greater population and reduce the overall need for emergent care. They also hypothesized expansion of SOPL would reduce the overall cost of care in states with expanded NP scope of practice laws By contrasting the care provided in states with expanded SOPL against those without it is anticipated evidence will show reduced cost and increased access to quality care.
Methods: A systematic review was conducted on literature related to quality of nurse practitioner care and scope of practice laws. Databases included CINAHL with full text, PubMed, ProQuest Central, and the Cochrane Library. Search terms included “nurse practitioners OR nurse clinicians AND primary care nursing OR nurse-practitioner OR nurse-clinician OR clinical-nurse-specialist AND physician OR doctor OR doctors AND nurse-clinician OR clinical-nurse-specialist AND physician OR doctor OR doctors AND economics OR microeconomic AND scope of practice laws.” Systematic reviews, randomized control trials, cohort, case control, or qualitative studies that focused on the effect of scope of practice laws on nurse practitioners’ quality of care, cost of care provided, and patient’s access to care were included. All included literature was
Results: Results will be given in the presentation.
Discussion/Implications: Past systematic reviews have examined the quality of care and cost effectiveness of NP’s with findings in the NP profession’s favor. However, there has not been a systematic review conducted to examine the effects of inconsistent scope of practice laws among states and the resultant differences in quality of care received by patients. It is anticipated that the evidence available will support the benefit of standardizing scope of practice laws across all 50 states resulting in increased patient access to high quality, and affordable care.
Project title: Evaluation of a Paper-Based Tool to Assist Clinicians in Addressing Weight in a College Health Population
Introduction/Purpose: Overweight/obesity presents a unique challenge in primary care and is a significant
risk factor for many chronic health conditions. The United States Preventive Services
Task Force (USPSTF) recommends screening all adults for obesity and states that clinicians
should offer or refer patients with a body mass index (BMI) of 30 or higher to intensive,
multicomponent behavioral interventions. Despite a great deal of evidence indicating
positive outcomes related to raising the topic of weight during patient encounters,
clinicians often do not address weight with patients. Barriers to addressing weight
in primary care practice include but are not limited to limited understanding about
overweight/obesity care, concern about negative consequences from bringing up a sensitive
topic, low expectations of success, lack of time and resources, and poor reimbursement
for counseling. The adoption of a standardized, paper-based tool in a college health
population can be used to target concerning BMIs in a timely, objective manner and
has the potential to break down some of the barriers primary care clinicians face
when addressing the topic of weight in clinical practice.
The purpose of this project was to evaluate the effectiveness of a paper-based tool in assisting primary care clinicians with raising the topic of weight among a college health population. The primary a.m. of the study was to provide primary care clinicians with a supportive platform that helps initiate the sensitive discussion of weight in clinical practice.
Methodology: This survey study was part of a quality improvement effort among clinicians at a campus-based college health clinic. The paper-based tool being studied was developed in collaboration with a social psychologist with expertise in motivational interviewing (MI). Pre and post intervention assessments were also developed in collaboration with the social psychologist and incorporate MI-style scaling questions. Prior to being asked to utilize the paper-based tool, clinicians were assessed via three different MI-style scaling questions that evaluated their current comfort levels with addressing weight in primary care (i.e. “On a scale of 0-10, how confident are you in raising the topic of weight in your practice?”). A space for subjective comments was provided on the survey. Clinicians who elected to participate were then presented with a paper-based tool that incorporates body mass index (BMI)-plotting and two MI-style questions that address weight, as well as a list of available resources to help interested patients in decreasing their BMI. Clinicians were contacted via email with bi-monthly reminders regarding the study. Emails contained an attachment of the paper-based tool and the offer for a new supply of printed copies if desired. After utilizing the paper-based tool for ten weeks, clinician comfort levels with addressing weight in primary care practice were again evaluated via the same three MI-style scaling questions. Pre and post intervention data was compared, and any subjective comments regarding the tool were analyzed.
Results: Results will be given in the presentation. / Discussion: Discussion will be based on study findings and will focus on application to clinical practice. / Implications: Implications stemming from the results will be presented in the presentation.
Project title: An Initial Investigation into Developing Nurse Practitioner Residencies in Wyoming’s Federally Qualified Health Center Network
Introduction/Purpose: The a.m. of this study was to identify interest in and the resources available
for the development of nurse practitioner (NP) residencies within Wyoming’s federally
qualified health center (FQHC) network.
As a large, rural state, Wyoming faces unique challenges regarding adequate primary care access. Recruiting well qualified providers is often identified as a major obstacle. Retention is also problematic as providers often experience poor job satisfaction when working with vulnerable populations, including the rural and underserved. Nurse practitioners provide a significant amount of primary care in Wyoming; however, the transition from student to independent practitioner is often described as tremulous and without adequate support. A potential solution to both Wyoming’s ongoing primary care shortage and NPs’ transition to practice is the development of NP residencies within Wyoming’s nine FQHCs. The nation’s first NP residency was started in an FQHC in Connecticut in 2007. Several similar NP residencies have opened across the U.S. in the years since. Initial data from these residencies indicates that they have been successful. An NP residency, in Wyoming’s FQHCs could improve primary care provider recruitment and retention by providing a structured, mentored, post-graduate residency with particular focus on Wyoming’s most vulnerable populations.
Method: This is a qualitative study using individual and group interviews collected through purposive sampling. Study participants were recruited through the Wyoming Primary Care Association website, which contained contact information for all FQHC directors. The directors were invited to participate in an interview and asked to forward the email invite to the FQHC providers. Background information was provided to interview participants prior to the scheduled interviews. Video/audio recorded, guided interviews were conducted lasting up to one hour. The interviews were transcribed for accuracy, then reviewed and examined using content analysis for broad themes related to the a.m. of the project. Emergent coding was employed after the interviews were complete. One interview was randomly selected to be reviewed by two individuals, a goal of 95% agreement on themes was set to minimize bias and increase reproducibility of this process.
Results: Preliminary results will be presented in a podium presentation.
Discussion: Discussion will stem from the results and will be presented.
Implications: The data will likely provide valuable information for innovative solutions to primary care access in Wyoming’s FQHCs and for newly graduated NPs.
Project title: System Improvement for Screening for Obstructive Sleep Apnea at Yearly Appointments
Introduction/Purpose: Obstructive sleep apnea (OSA) is a common problem with successful treatment options.
Many people have OSA but are unaware; therefore, treatment is not initiated. Such
individuals may suffer from the many negative consequences of untreated OSA. Because
OSA is often under diagnosed, efforts need to be made to improve detection and treatment
of this health condition. This study evaluated a system level improvement aimed at
increasing diagnosis of OSA at a rural, primary care clinic. The project objective
was to evaluate whether formal screening for OSA through the use of the Berlin Questionnaire
(BQ) would increase the detection and diagnosis of OSA in a primary care sample of
patients aged 35-70 years old.
Methodology: Individuals presenting for annual appointments were given the BQ to complete. Providers at the clinic reviewed and scored the questionnaire. If individuals screened positive based upon scoring guidelines of the BQ, providers discussed results with the respective individual. If the provider deemed necessary, additional testing was ordered to further evaluate a possible OSA diagnosis. Providers were asked about ease in using the screening tool and feasibility of completing the screening in clinical practice. Quantitative data were collected to determine if screening for OSA resulted in improved diagnosis of OSA.
Results: Forty-two of 156 qualifying individuals were screened using the BQ. Of these, 31% (13 individuals) screened positive. Two individuals who scored positive were referred for additional testing. Three individuals declined any further testing. Five individuals did not receive the recommendation for additional testing for possible OSA. Three individuals already had a diagnosis of OSA.
Discussion: Twenty-seven percent of appropriate individuals were screened. However, for those individuals screened, 31% did screen positive. The majority of these individuals received additional discussion and counseling regarding the positive results. It is reassuring that those individuals who were already diagnosed with OSA had a positive screening result. Several individuals received the recommendation for additional testing, but there were no cases of individuals being diagnosed during this study timeframe.
Implications: Overall, data are insufficient to determine if screening for OSA using the BQ was effective in the rural, primary care site. However, needed adjustments to the implementation methodology were identified, including involvement of nursing staff in the screening process to improve screening rates. With adjustments, implementation of the system improvement would potentially result in an increase in identification and treatment of OSA.