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The University of Wyoming Fay W. Whitney School of Nursing's Doctor of Nursing Practice (DNP) Program will be holding "School of Nursing Research & Scholarship Day" on Wednesday, April 24, 2019 at the Center Ballroom in the Wyoming Student Union, presenting a packed agenda from 8:15 a.m. to 5 p.m.
This event marks the culmination of studies and project preparation by the 2019 DNP Graduate Candidates. Eighteen students will present their research findings from either a quality improvement project recommended by a clinical agency, or from a systematic review of a subject of high interest to the candidate.
Scroll down to read what each student shared as their biggest impression so far from their study on their particular subject. Then join us for "the rest of the story" on April 24th. Student presentations are scheduled from 10:15 a.m. to 2:30 p.m.
This quality improvement project has been a great personal reminder related to the need for increased awareness of health literacy. Non-urgent emergency department visits occur for many reasons including psychosocial and biophysical factors; however, a decreased level of health literacy seems to be at the root of many of these reasons. Due to this fact, I now have a better realization that healthcare providers should routinely assess for health literacy and provide subsequent tools and resources in order to increase health literacy among the general patient population.
The unpredictability of homeless patients schedules and limited resources often makes coming to an appointment difficult. Therefore, the availability of the walk-in clinic made care accessible when they were able to seek it. The number of patients coming to the clinic every day, being willing to wait and return the next day if needed, was encouraging. It was great to see the number of people making health a priority when they have so many other things to worry about. The success of the walk-in clinic in improving the number of patients seen was incredible.
There were two specific things during the project that really struck me. The first was getting a true feel for what quality improvement is and the process that takes place. We were fortunate enough to get to work with an experienced member of the hospital’s quality improvement department. She helped us truly understand and implement the steps that we had learned while guiding us through the process for the best possible results. The second was the impact that a small change can have with an eager and receptive audience. Through the implementation of a brief suicide training we were able to see impressive changes in the confidence and knowledge of the staff that participated. These changes will hopefully not only have an impact on those that participated but have a positive impact on all of the patients they work with, as well as the community as a whole.
[Written with Jeff Shideman.] We worked with Heritage Health Center in Powell, WY, a small Federally Qualified Health Center, to assist them in standardizing their clinic workflow processes and to increase patient engagement. Collaborating with their staff, we aimed with our interventions to improve outcomes for their patients living with type 2 diabetes and hypertension. What impressed us most was how they overcame unforeseen logistical challenges to trial our shared interventions for the benefit of their clinic. We have also been especially pleased to see Heritage Health Center embrace our daily morning huddle intervention and carry it forward after we leave. Being able to have a lasting, positive influence working together with their staff during the project was great.
It has been an honor to play a small part in trying to increase enrollment in the fledgling medication-assisted treatment (MAT) clinic at the Sheridan VA. One of the biggest eye-openers to me has been to see how vulnerable veterans are to substance abuse, particularly in connection with post-traumatic stress disorder. However, the VA is working hard to reach veterans in all the outlying outpatient clinics who need treatment for opioid addiction. Many of the veterans have never heard of MAT or do not realize it is available nearby. Our hope is that, if veterans seeing their primary care providers are screened for opioid use disorder regularly, more of those needing help may get the treatment they need and deserve.
What made the biggest impression on me during the project with Ivinson Memorial Hospital Cancer Center, was the enthusiasm of the team members involved. The staff at the Cancer Center were extremely eager to engage in extra training that might assist a patient during a fragile time. They were already aware of the increased risk for suicide in patients receiving a cancer diagnosis and assessed this risk frequently. However, they wanted to be more adept and standard in assessing their beloved patients. After completing an education aimed at increasing confidence, competence and knowledge when conducting a suicide assessment, the cancer center staff felt they were much better able to discuss the topic of suicide more effectively and effortlessly with their patients. It was very fulfilling to complete my DNP project with a group of people that show such genuine compassion, commitment and passion for their patients.
In my short time working with the Downtown Clinic in Laramie WY I have been amazed at how much the volunteer team works to do what is best for its patients. This project was implemented to improve follow-up for patients with diabetes and hypertension to assure that they are getting the appropriate lab work, exams, and visits to ultimately improve the control of their chronic conditions. The staff was not only receptive to our project, but supportive and grateful as well. There is a great team there that is willing to go beyond typical measures to ensure patients can get to visits including calling them to schedule, and helping to find transportation. This look at healthcare has inspired me to be the best practitioner I can be.
The biggest impression from my work on my research project was that the resistance of patient portal use among some providers was much higher than I anticipated. I originally promoted this project due to a provider encounter I had at Denver Health. She had been a PA for over 20 years, and loved how the patient portal allowed her to interact with patients while decreasing workload for support staff and her personal medical assistant. The fear of increased provider workload is a hard obstacle to overcome.
I was astounded by the impact of a trusted point of contact, such as a case manager, within a healthcare setting can have on the overall health of a patient and can influence where they choose to seek care. Sometimes patients are concerned about paying for basic needs, such as housing and food, and paying a primary care visit copay can seem daunting. However, when a person reaches out to these patients and offers a helping hand, whether it be in the way of emotional support or financial planning, patients choose to seek care in a more appropriate setting. Having a relationship with a primary care office can allow patients to avoid the need for emergency care through prevention, and is helpful in navigating the complicated health care system.
The biggest impression that I found with this project was that even though it is a single aspect of the complex issue of maternal and child health outcomes in Wyoming, increasing preconception health counseling conversations is an excellent starting point. By asking just a couple of simple questions regarding pregnancy intentions, it is possible to help identify maternal health risks and to thereby promote healthier pregnancies and birth outcomes. I think that technology and electronic health record templates are helpful tools that can remind providers to ask preconception health questions for every woman at every visit. In this way, more important discussions about maternal and child health will occur.
I initially became interested in medication error reporting, as it relates to the concept of 'Just Culture' in healthcare environments. This interest led me to look more closely at vaccination errors, as they relate to both individual and population health. It has been fascinating to sort through the literature on this subject, and to see what a profound effect both communication and logistics have on vaccination errors. Although errors commonly occur in healthcare, there is often under-reporting of this information. As I reviewed the literature, I was excited to see a movement toward more open dialogue about errors and how to improve safety.
The aspect that left the largest impression on me while working on my research project at the Downtown Clinic in Laramie, was the clinic itself. The clinic fills a gap in healthcare in Laramie that would significantly and negatively impact the community if it did not exist. If it wasn't for the caring and compassionate individuals at the clinic, we would not be able to serve the uninsured and undeserved populations in our community. The staff and volunteers at the clinic are always looking for ways to help create access to healthcare that the individuals they serve would not get otherwise. It was wonderful to have the opportunity to work along side them to help improve the care given to their patients.
I was astounded by the potential impact small interventions can have on the broader health picture. Inappropriate utilization of healthcare resources leads to increased healthcare costs and poorer patient outcomes. We were able to see within 2 PDSA cycles that simple acts such as asking patients about their primary care utilization and providing them the opportunity for direct integration into a primary care could impact the outcomes of hundreds of patients seen at the Community Health Center of Central Wyoming. These interventions were free to initiate, meaning no additional costs to healthcare payers. To date, the interventions we initiated have been implemented as a part of the standard operating procedure in this FQHC and are redirecting patients from urgent care to primary care to ensure an optimal level of healthcare. I am thrilled to have been a part of this quality improvement project and look forward to sharing our results on Nursing Scholarship Day.
I knew I wanted to study family interventions in first-episode psychosis (FEP) at Peak Wellness Center in Cheyenne the moment I heard about their FEP program. Ultimately, there were not enough participants for my initial DNP quality improvement project, so I had to go with Plan B, a systematic review. Delving so deep into the literature was eye-opening, time-consuming, and arduous, yet well worth the experience. Ultimately, I learned how to thoroughly evaluate the quality and the outcomes of all of the available evidence on my chosen topic. While there is ample evidence of the success of family interventions in well-established schizophrenia, the evidence on the effectiveness of such interventions in early psychosis is lacking. It was through this review that I was able to discover there is a shortage of evidence on this critical topic.
[Written with Randy Baxter.] We worked with Heritage Health Center in Powell, WY, a small Federally Qualified Health Center, to assist them in standardizing their clinic workflow processes and to increase patient engagement. Collaborating with their staff, we aimed with our interventions to improve outcomes for their patients living with type 2 diabetes and hypertension. What impressed us most was how they overcame unforeseen logistical challenges to trial our shared interventions for the benefit of their clinic. We have also been especially pleased to see Heritage Health Center embrace our daily morning huddle intervention and carry it forward after we leave. Being able to have a lasting, positive influence working together with their staff during the project was great.
It has been inspiring to be part of continual quality improvement work at Cheyenne Regional Medical Center’s Behavioral Health Services unit. This project has allowed me to take part in a few measurable interventions for improved patient flow. However, I also got to see quality improvement as it should be: ongoing, evolving, and transformational. Staff and management in both the emergency department and inpatient psychiatric unit continue to brainstorm, test interventions, and negotiate for improvements. For a few months, I got to be part of a culture that works together for constant QI. I am excited to carry forward that momentum and energy in my future as a PMHNP.
These projects provided the opportunity for us as students to see the impact we can make with a well-planned, well-executed quality improvement project. Our project at Community Health Center of Central Wyoming has the potential to improve health outcomes at no additional cost to the clinic. Additionally, it prepared me to execute future quality improvement projects and impact the landscape of healthcare in my community. I hope the impact of this project inspires others to participate in quality improvement measures. I am excited to share the results of this project at Nursing Scholarship Day!
Working on this quality improvement project reminded me how complex treatment for many mental health disorders, including opioid use disorder, can be. However, with integrative and creative approaches, changes can be made that benefit patients, especially those living in rural parts of Wyoming. I hope this project begins the process of improving how primary care providers identify at-risk veterans so that more veterans can access treatment for opioid use disorder.