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Purpose. The purpose of this DNP project is to educate rural primary care providers and staff on postpartum depression (PPD) and implement the Edinburgh Postnatal Depression Screening tool (EPDS) in the San Pedro Clinic in Benson, Arizona. Background. PPD is a common complication of pregnancy and rural communities are at an increased risk for PPD due to limited resources and providers. If PPD goes untreated it can impair the maternal-newborn bond, decrease breastfeeding, increase the risk for paternal depression, and adversely affect the cognitive and physical development of the newborn. There is a need to educate primary care providers working in rural clinics to increase PPD screening. Methods. A pre-/post-education survey was administered to the healthcare providers and staff at San Pedro Clinic after an educational presentation was given on PPD highlighting risk factors, screening tools, and evidence-based practice. The EPDS tool was implemented into the charting system and the total number of uses four weeks after the educational presentation was assessed. Descriptive statistics were analyzed to measure pre- and post-education findings. Conclusion. This project increased provider awareness, knowledge, confidence, and intent to screen for PPD through post-education surveys. However, during the four-week trial phase, the EPDS tool was not utilized. Some of the barriers that were noted included limited pediatric interactions daily, adopting a new procedure, and the inability to provide electronic reminders.

Purpose: Improve team members' knowledge of omega-3 fatty acids at New Path Mental Health and Wellness and increase their motivation to consider omega-3 supplementation for psychiatric patients with depression or depressive symptoms. Background: Dietary patterns in Western societies have witnessed changes in omega-6/omega-3 polyunsaturated fatty acid (PUFA) food supply, contributing to inflammatory diseases such as depressive disorders. Research investigating the association between omega-3 PUFAs and depression suggests that omega-3 intake may play a preventative role in depression and serve as an adjunct to treatment. Methods: A voluntary twenty-minute educational PowerPoint was offered to the interprofessional team at New Path Mental Health and Wellness during a routine monthly staff meeting. After the presentation, a post-assessment handout was distributed to determine participants’ knowledge of omega-3 PUFAs and willingness to implement omega-3s in practice. Results: The educational PowerPoint intervention advanced each team member’s understanding of the role of diet and omega-3 PUFAs in depression. Each participant reported enhanced knowledge and agreed to consider implementing omega-3 PUFAs into practice. Conclusions: This quality improvement project increased provider knowledge of omega-3s and their likelihood of implementing omega-3 supplementation in practice. New Path team members recognize the barriers to adequate nutritional intake and believe that education and supplementation are feasible to prevent and treat depressive symptomology.

Purpose: Within a rural Arizona community, this quality improvement project aimed to improve diabetic patients' knowledge of diabetic medication side effects. Background: Diabetes mellitus is one of the leading causes of morbidity and mortality in the United States. Rural populations in Arizona have a disproportionately higher rate of diabetes diagnoses. Providing information to patients about the side effects and adverse reactions from the medications used to treat diabetes can increase patients’ confidence in their treatment, improve medication adherence, and enhance communication with their providers. Methods: The diabetic patients of a rural community health center were given an educational pamphlet explaining the common side effects of medications used to treat type 2 diabetes. A pre- and post-survey were conducted to gauge whether knowledge improved after reading the pamphlet. The pamphlet and surveys were distributed in hard copy with a link to complete online if desired. The Adult Learning Theory theoretical framework inspired the project and was created with the guidance of the Model for Improvement created by the Institute for Healthcare Improvement. Results: Project findings indicate an educational pamphlet can effectively increase antidiabetic medication side effect knowledge in a rural family health clinic. While the improvement was not statistically significant due to the small sample size, every participant increased their knowledge scores after participating in the quality improvement project. Patients’ confidence in calling the provider and seeking emergency care after experiencing medication side effects improved significantly (p<0.003, p<0.002). Project limitations included language barriers, convenience sampling, and a homogenous sample population.

Purpose: Quality improvement project aimed to increase patient portal activation through increased provider promotion. Background: Patient portals give patients access to after-visit summaries, medication lists, lab results, appointment reminders, and a means of communication with their providers. Though there is increasing interest in patient portals, a notable underutilization occurs from both patients and providers. Increased provider interest and promotion of the patient portal to their patients can increase patient interest and increase patient portal activation. Methods: An educational huddle was developed and delivered to providers and clinic staff members regarding the importance and benefits of patient portals. Pre- and post-surveys were administered to participants to identify how many providers promote the portal, why they do or do not promote it, and how likely they are to start promoting after learning its benefits. Results: Ten participants were involved: four providers, one nurse, three medical assistants, and two front desk/receptionists. Some 80% reported they did not promote the portal before the educational huddle, and 50% reported that they would still need to promote it after the educational huddle. Highlights for the lack of promotion include a need for more awareness of the portal, its usability, and its components for the hesitancy in promotion. The portal activation percentage improved from 32% to 39% in the two-week timeframe of the project. Conclusion: The study findings were positive in improving the promotion of the patient portal and understanding what keeps providers from promoting the portal. It has a more significant impact in setting the foundation for future practice implications. A common theme of the lack of promotion was a lack of confidence due to unawareness of the patient portal. This knowledge deficit can guide future quality improvement projects within the San Luis Walk-in Clinic to optimize the benefits of the patient port

PurposeThe purpose of this quality improvement project is to increase awareness about burnout in primary care NPs and educate providers about evidence-based interventions to mitigate feelings and experiences of burnout. The goal is to introduce an intervention that is widely accessible, efficient, and user-friendly to prevent burnout. Background Burnout is a state of emotional exhaustion that commonly affects healthcare workers. It is characterized by emotional exhaustion, depersonalization, and decreased personal accomplishment. Primary care nurse practitioners are a growing workforce and are vulnerable to experiencing burnout; however, current literature is lacking regarding burnout and effective interventions for this population. Mindfulness is a practice that focuses on self-awareness and acceptance of the present moment. Due to its accessibility and usability, it can be an effective method to combat burnout. Methods Primary care nurse practitioners from Arizona Community Physicians were recruited via the provider newsletter to participate in two weeks of daily, 10-minute mindfulness meditation using the Healthy Minds Program mobile application. Participants were asked to complete the Maslach Burnout Inventory for Human Services Survey for Medical Personnel before and after completing two weeks of mindfulness meditation. Results Three participants completed the surveys and interventions. Mean scores for each Maslach Burnout Inventory subscale (depersonalization, emotional exhaustion, and personal accomplishment) improved after just two weeks of mindfulness practice, although these differences were not statistically significant. Conclusions Burnout is prevalent yet under-researched in primary care nurse practitioners. This quality improvement project sought to identify and mitigate burnout through mindfulness meditation. Further research is needed to assess the full impact of mindfulness on burnout in primary care nurse practitioners.

Purpose: Hyperlipidemia has been identified in over three million persons in the United States and Europe, and the number is constantly increasing (Hill & Bordoni, 2022). Many people are uninformed of the need to control hyperlipidemia and are unaware of the severe problems that might result from this condition. This study intends to increase awareness of hyperlipemia by educating participants about the necessity of hyperlipemia management through a booklet and provider education. Background: Hyperlipidemia is an excess of fats or lipids in the body (Cleveland Clinic, 2022). Extra lipids or fats cause issues by forming plaque in the blood vessels, restricting blood flow via the arteries (Mayo Clinic, 2023). Atherosclerosis is caused by the deposition of cholesterol-causing plaque, which can lead to a heart attack, stroke, coronary artery disease, carotid artery disease, peripheral artery disease, microvascular disease, and sudden cardiac arrest (Cleveland Clinic, 2022). Methods: Flyers were posted in the clinic of Dr. Eric Chwa, and patients who want to participate have signed consent and agreed to partake in the quality improvement (QI) project. Patients first received a pretest to test their baseline knowledge. After the pretest, they were given a pamphlet and a 15-minute education about hyperlipidemia. After the completion of the in-person instruction, the patient took a posttest. Results: Twelve participants took part in the QI Project. A comparison of the pre-and posttest shows a 16% improvement in test scores. A paired t-test conducted on the pre-and posttests shows a statistical significance that the Quality Improvement Project improved patients' understanding of hyperlipidemia. Conclusion: The quality improvement project improved patient's understanding and awareness of risk factors. However, data may be skewed due to its limited sample size.

Purpose: Purpose of this quality improvement (QI) project was to increase provider knowledge, self-efficacy in antibiotic prescribing, and stewardship in outpatient clinic settings.Background: Antibiotics can alleviate suffering and provide life-saving effects when used appropriately. Antibiotic resistance accompanied exponential increase in use and overprescribing antibiotics, resulting in over 2,000,000 resistant infections, and leading to 23,000 preventable deaths in United States annually. Additionally, preventable morbidity/mortality, antibiotic resistance contributes to significant financial burdens, particularly within outpatient settings. Approximately 60% of antibiotic expenditure occurs within outpatient settings; 20% of pediatric and 10% of adult visits resulted in inappropriate antibiotic prescriptions. According to Centers for Disease Control and Prevention (CDC), 30% or more antibiotic prescriptions within outpatient settings are unnecessary. Antibiotic stewardship programs aimed at educating primary care providers emerged to moderate antibiotic prescriptions, including dosage, route, duration to mitigate negative effects such as antibiotic resistance, and infection recurrence. Nurse practitioners provide 69% of primary care, and serve as potent champions for antibiotic stewardship, advocacy, and education for patients within primary care settings. Methods: Posttest survey was administered to primary care providers in outpatient settings. Willing providers attended a 20-minute post-intervention session based on CDC’s Antibiotic Training Series. Immediately following education session, participants completed posttest survey aimed at assessing acquired knowledge, attitudes, self-efficacy, and confidence in antibiotic prescribing. Posttest survey also included general ratings and attitudes of participants regarding education sessions. Findings: Four out of five invited providers participated in 20-minute educational session. Participating providers rated

Purpose. The purpose of this project was to improve the knowledge of providers in a southern Arizona federally qualified healthcare center (FQHC) homelessness outreach team about cardiopulmonary resuscitation (CPR) outcomes, to facilitate increases of advance care planning (ACP) for FQHC’s persons experiencing homelessness (PEH) population. Background. Primary care is the central setting of conversations about advanced care planning. Providers offer ACP, when possible, but no simple method exists to focus this care where it is needed. Health illiteracy surrounding CPR is well-documented and a frequent barrier to advancing the ACP conversations. Methods. This quality improvement project (QIP) was designed to improve provider knowledge around CPR outcomes in advance care planning (ACP) using a validated, educational video decision aid (VDA). Results. The CPR VDA did increase provider knowledge about CPR outcomes. Two of the three objectives were met: Outreach providers were educated; Measurement of knowledge change as a result of the intervention was completed. Conclusions. QIP was successful but there were limitations of time and sample size was small. Sustainability of project is currently under review with the QI department of organization. Dissemination of project will occur with sharing of QIP results with FQHC outreach department, organization’s QI department, at organization’s spring QI Fair event and two regional rural health conferences.

Purpose: This project aimed to address and enhance patient outcomes by implementing qualityimprovement strategies in a local primary care clinic. The project targets optimizing workflow processes to reduce patients' wait times and elevate patient satisfaction and staff efficiency. Background: Prolonged patient wait times in outpatient primary clinics have been identified as a significant issue, leading to fragmented workflows, increased staff stress, and diminished patient satisfaction. This project addresses these challenges by optimizing workflow and standardized care processes. By targeting the root causes of extended wait times, the project aims to contribute to a healthcare environment characterized by enhanced efficiency, patient-centric care, and improved patient satisfaction for both patients and healthcare providers. Methods: The project adopts a structured approach grounded in Lewin's change theory and guided by the Plan-Do-Study-Act (PDSA) cycle. Extensive literature reviews inform the identification of key themes, including scheduling optimization, process standardization, and care coordination. The intervention involves redesigning the daily appointment schedule and introducing a checklist for staff roles. The comprehensive evaluation incorporates staff surveys and data collection on patient wait times. Results: Pre-intervention analysis reveals a fragmented workflow contributing to increased wait times and staff dissatisfaction. Initial staff surveys show diverse perceptions, and baseline patient wait times are measured at an average of 30 minutes. Post-intervention results demonstrate a significant increase in staff satisfaction scores and positive shifts in perceptions of efficiency. Despite these positive outcomes, the project acknowledges challenges in rapid implementation, emphasizing the need for a phased approach and active staff involvement.

Purpose: This quality improvement project aimed to increase the awareness and utilization of select lifestyle modifications that can positively impact and support fertility. These lifestyle changes aimed to support the overall well-being of those seeking fertility treatment. Background: Infertility rates are impacting the declining number of births in the United States (US). One in five couples in the US have difficulty conceiving. The prevalence of infertility in Utah is 10-20%. There are many causes of infertility, and some are non-modifiable. However, the awareness of lifestyle choices and their impact on conception is lacking. Methods: Recruitment for the project took place via advertisement on the Utah Infertility Resource Center Facebook support group page. A PowerPoint slide deck and verbal information were presented at Meet Me on 33rd, Millcreek, Utah. After viewing the presentation, participants were provided eight post-survey questions. These responses were recorded and measured privately. The results of these responses evaluated the effectiveness of the presentation materials. Results: Fourteen women responded to the post-survey questions. The overall results from the analyzed data indicated that 50% of participants strongly agreed that their knowledge of lifestyle factors that support fertility increased, and 64.3% of participants strongly agreed that they are likely to utilize these modifications in their own lives. Most (71.4%) of participants desired further information on the topic. Conclusions: The educational presentation was influential in raising awareness regarding lifestyle factors that support fertility and overall well-being. The presentation included practical ways women can support their fertility through lifestyle changes. Further education and projects are needed to increase provider knowledge in this area so women of childbearing age can become aware earlier.

Purpose: The purpose of this project was to educate care managers at North Country HealthCare on modifiable risk factors of hypertension and the Teach-Back method and to provide them with a handout on modifiable risk factors for hypertension so that they would improve their knowledge of the subject matter by at least 10%. Background: Almost half of the American population have hypertension. Studies have shown that patients can lower blood pressure by using modifiable risk factors such as diet, exercise, limiting salt intake, smoking cessation, and decreasing stress levels. Methods: The Teach-Back method is a tool that providers can use to help practitioners teach patients to retain knowledge in a clinical setting by asking the patient to repeat the information the patient received during the visit and fill in any knowledge gaps. The educational meeting was conducted via a Zoom meeting, and questions were provided via a pretest/posttest survey. Results: Understanding the Teach-Back method may be vital in helping care managers pass information, such as modifiable risk factors for hypertension, to their patients. Care managers demonstrated an understanding of the Teach-Back method based on a demonstration activity. Care managers demonstrated a baseline understanding of modifiable risk factors of hypertension based on pretest results with an improvement of the Teach-Back method based on posttest Results.

Purpose/Aim: This quality improvement project explored the effect of an educational session on reducing weight bias in primary care providers and strengthening the patient-provider relationship. Rationale/Background: Weight bias is a negative attitude or belief about people with overweight or obesity. Weight bias has physical and psychological effects on patients, which can lead to poor health outcomes and loss of trust in the healthcare system. One major adverse effect is decreased healthcare utilization. Weight bias has also been linked to several other psychological and physical consequences. Many providers exhibit weight bias unintentionally through avoidance of initiating weight loss conversations, which is a disservice to patients. Sensitive communication has been shown to improve patients’ willingness to actively participate in their care plan. Brief Description of Undertaking: Lewin’s Change Model in conjunction with the RE-AIM model was used to guide the project. An implicit and explicit weight bias survey was administered to primary care providers to assess their baseline weight bias and comfortability in initiating weight loss conversations with patients. A synchronous in-person education intervention was delivered to providers working in a primary care clinic. The education included evidence-based information regarding obesity, the damages of weight bias, and how sensitive communication can build positive relationships with patients, thus improving their health outcomes. Outcomes Achieved: Results of the pre- and post- education surveys were analyzed. The data supported an increased willingness to discuss weight in a sensitive manner with patients. The 11 participants had a high baseline knowledge of obesity and weight bias but expressed the appreciation for a refresher regarding personalized communication when discussing patients’ weight journeys. Conclusion: This project aimed to decrease implicit and explicit weight bias behaviors in primary care prov

Purpose: The purpose of this quality improvement (QI) project was to educate adult learnersfrom the Telehealth Learning Center (TLC) at the University of Arizona on proper liquid medication preparation for the pediatric population, focusing on dosing accuracy. Background: Previous studies have found that parents and caregivers of children are dosing liquid medications inaccurately at home at a high rate. These dosing errors may contribute to adverse drug events (ADEs) ranging from minimal harm to death and, subsequently, additional healthcare costs. Rushed post-discharge processes and ineffective healthcare provider medication education and counseling have been identified as contributing factors to these high rates of dosing inaccuracy. Educational counseling strategies have been associated with improving the rates of dosing accuracy among caregivers of children. Methods: For this quality improvement (QI) project, 19 participants were recruited from the University of Arizona’s Telehealth Learning Center. These participants took part in a telehealth- like educational counseling session via the Zoom platform. Pre- and post-surveys focusing on liquid medication preparation and administration were conducted through Qualtrics to assess demographics, knowledge, confidence, and intent to use information learned. A manual test, performed pre- and post-intervention, evaluated participants’ ability to dose accurately. Results: Nineteen total participants completed the pre- and post-intervention tests. The data from the pretests and posttests found that post-intervention liquid medication dosing accuracy and knowledge of medication preparation and administration improved. Self-reported confidence rates in the ability to dose accurately were high in the pretest. These confidence rates decreased slightly in the posttest. Participants self-reported the education session to be informative and were likely to use the information learned in the future. Conclusion: The results of this

Purpose: The purpose of this quality improvement project was to increase SARS-CoV-2 vaccination confidence and knowledge in adults who display reluctance or hesitancy through a brief educational discussion and a written pamphlet. Background: In recent history, the world was faced with an unprecedented challenge as a pandemic quickly encompassed the globe. In early 2020, this became commonly known and referred to as the COVID-19 pandemic. The severe health implications of this respiratory virus quickly overfilled hospitals and placed the health of communities at risk. To get ahead of further spread of COVID-19, it was pertinent to quickly develop an effective vaccine. Following rigorous clinical trials, two mRNA vaccines were approved by the United States (US) Food and Drug Administration (FDA). What seemed like a solution became a challenge within the US. The population of the US showed reluctance to participate in COVID-19 vaccination programs. Vaccine hesitancy related to COVID-19 mRNA vaccines prolonged communities achieving adequate herd immunity. Understanding why individuals were displaying vaccine hesitancy was pertinent for implementing strategies that would lead to increased mRNA COVID-19 vaccine compliance. Methods: Participants were recruited from Peak Family Practice in Colorado Springs, CO. A pre-survey was administered followed by a short one-on-one educational session reviewing a written pamphlet about mRNA vaccines and common misinformation related to COVID-19 vaccines. A post-survey was administered after the educational intervention. Each survey had the same five questions and assessed participant knowledge and confidence related to mRNA COVID-19 vaccines. Results: A total of 20 participants completed the pre- and post-survey responses, along with participating in the short educational session. No statistically significant differences were found, however, participants who changed their answers on post-survey showed an increase in confidence of mRNA

Purpose: The purpose of this Doctor of Nursing Practice project was to implement a quality improvement project to evaluate whether patients value home-health checks by community paramedics in Montana. Background: Rural areas are vulnerable to ED overutilization because of the lack of health care services. Research has shown that community paramedicine programs help fill the primary care gap. Community paramedicine can expand primary care’s reach by performing patient assessments and procedures within their skillset. However, there is a lack of research on paramedicine program enrollees’ perception of programs and programs are finding difficulty in funding such programs. Methods. This project used quantitative and qualitative analysis to examine a convenience sample of (n=15). Participants were enrolled in the Community Care program in Carbon County who participated in the questionnaire. After concluding the visit, the participant would voluntarily complete a questionnaire. Data analysis was conducted using descriptive statistics and a qualitative response was scanned for emerging themes. Results: A total of (n=15) participants completed the questionnaire. The results showed a use rate of 76.9% of enrollees that had used the community care team previously and 23.1% had not and was receiving a home health visit from the Community Care team for the first time. 60% of participants have gone to the emergency room before to seek care due to their primary care provider not being available. 93.3% of participants answered they would seek care at the emergency room if this program was not available. Illness knowledge was assessed using the Likert scale. Out of the 15 responses 9 responses had a score of 3 or less. Necessity, funding, communication, and improving advertisement, as well as security were commonly presented themes within the 15 questionnaires. Conclusion: This project shows encouraging results for the effectiveness of this program preventing unnecessary hospital

Purpose: The purpose of this quality improvement project was to educate psychiatric providers on mental health apps and improve competency in app evaluation. Background: Mental health apps offer the potential to increase access to care and improve health outcomes. Apps are especially promising for rural residents who face barriers to care and are more likely to die by suicide than their urban counterparts. While there are thousands of mental health apps available, the quality of apps varies dramatically. Some apps may contain harmful information, and others compromise patient privacy. Psychiatric providers need to know how to evaluate apps. Methods: A 20-minute training session was conducted targeting psychiatric providers in Northern Arizona. Attendees were provided education on mental health apps, in particular suicide prevention apps. A patient-centered teaching tool, developed by the primary investigator, was used to teach critical elements of app evaluation. After the training, attendees completed a survey to measure the success of the training. Results: Thirty-eight people attended the training. Of those, 13 consented to participate, including nine nurse practitioners, two physicians, and two non-clinical employees. Most participants work predominantly in outpatient behavioral health settings with patients who reside in rural areas. Participants reported that their knowledge of mental health apps increased after the training (p = 0.00338), and their comfort in app evaluation improved (p = 0.00512). An overarching theme emerged from participants’ responses to questions regarding the risks and benefits of mental health app use, which was safety. Participants stated that they plan to apply the knowledge gained during the training to their clinical practice. Conclusions: In an increasingly digital world, clinicians must know how to discern quality apps. This quality improvement project achieved all of the primary objectives. It also demonstrated that a patient-cen

Purpose. This quality improvement project aimed to assess nurse practitioner mentorship experiences, compare these experiences to job satisfaction, retention ratings, and intent to mentor. Background. Novice NPs report feeling inadequately prepared to practice independently following graduation, this perception of under-preparation negatively affects job satisfaction and retention. Postgraduate mentorship is associated with increased satisfaction scores among novice NPs and improved patient outcomes. Researchers have identified links between formal mentorship relationships for postgraduate NPs, increased NP job satisfaction, and retention rates. Despite challenges in recruiting providers to rural underserved areas, mentorship is frequently not studied in rural practices. Methods. Recruitment of 5-10 potential NP participants practicing in a rural Southern Utah clinic setting and willing to attend mentorship-focused group meeting via Zoom. Immediately following a brief educational session focused on the value of NP mentorship, each participant completed short surveys reporting previous mentorship experiences, Misener’s Nurse Practitioner Job Satisfaction Scale, Price’s Intent to Stay Scale, and a survey of their intent to mentor in the future. Intent to Stay Scale acted as a proxy for retention. The project manager addressed questions participants might have, facilitated discussion about mentorship, and assessed participants’ intent to participate in NP mentorship in the future. Results. Six local practicing NPs participated in virtual group mentorship educational session. Each NP’s mentorship experience was compared to job satisfaction and retention survey results to determine the association between mentorship relationships, job satisfaction, and retention. Four participants reported previous mentorship experiences. All participants reported an interest to mentor in the future. A high overall mean score (232/264; 88%) respectively indicates high levels of job satis

Purpose: The purpose of this quality improvement project was to increase the conviction, confidence, and intention to adopt the teach-back method among clinicians at a specialty clinic in Tucson, Arizona. Background: Health literacy is a pressing national and local issue. Low levels of health literacy are associated with poor health-related outcomes including increased hospitalizations, higher healthcare expenditures, and increased rates of morbidity and mortality. An evidence-based method to improve patient understanding is the teach-back method. With this method, the provider asks the patient to explain, in their own words, what they should know or do after it has been taught to them. This allows providers to assess misunderstandings and clarify misinterpretations. The use of teach-back improves medication adherence, reduces hospital readmission rates, increases patient satisfaction, and improves clinician confidence in teaching effectiveness. Methods: This quality improvement project was a description of the outcome of a change proposal utilizing the plan-do-study-act cycle. A pretest/posttest design with an educational intervention was utilized. Four clinicians within a specialty clinic in Southern Arizona participated in an online educational intervention known as the Interactive Teach-back Learning Module. The online pretest was administered before the participants viewed the module to identify baseline conviction, confidence, and use. The link to the pretest and the link to the educational module was sent to the participants via email. The link to the posttest was sent via email, 14 days after the initial email, to evaluate change. Results: The recruitment email was sent out to seven clinicians. Four clinicians (57.1%) completed the pre-survey, intervention, and post-survey. The interactive module was found to positively increase clinician familiarity, conviction, confidence, and use of teach-back within the setting. The consensus was that the module was an e

Purpose: This project aimed to increase advance care planning conversations, between patients and primary care providers, at the Benson Family Care Clinic, through educating staff and making changes to clinic processes. Background: When implemented, advance care planning can have far reaching effects, which benefit patients and families. Over the past few years, there has been a movement in health care to promote advance care planning in primary care. Unfortunately, only about 33% of Americans have advance directives. Further, research shows that health care providers may not be comfortable having advance care planning conversations. The literature indicates that endeavors aimed at increasing health care staff knowledge and comfort, in advance care planning discussions may benefit patient outcomes. Methods: Three plan-do-study-act cycles were completed, which included iterative tests of change. Methods involved educating clinic staff and administration, and implementing system change. Participants in this project were five clinic staff members to whom an educational workshop was presented. The workshop included role-play with a standardized patient. System changes included increasing patient visit time for Medicare Wellness Exams from 30 to 45 minutes, which gave providers time to engages in advance care planning discussions. Pretest and posttest surveys assessed changes to participant self-perception of advance care planning conversations. Reports of advance care planning billing codes were used as a surrogate measure of advance care planning activity. Results: Baseline advance care planning activity was zero before this project began. By project end, 54% of patients seen for Medicare ‘well visits’ received advance care planning services. Further, project participants had an aggregate increase of 77% in self-assessed perceptions of advance care planning conversations after the educational workshop. Conclusions: This project was highly successful. Project findings s

Purpose: The purpose of this study was to describe suicide loss survivors’ experiences and barriers to accessing support and mental health care. The aims were 1) explore suicide loss survivors’ physical and psychological health experiences related to suicide, 2) identify potential barriers to accessing support and mental health care. Background: Suicide is a complex public health problem in the United States. People bereaved by the loss of someone to suicide often experience significant mental and physical problems along with increased incidence of complicated grief, exposure to stigma, and barriers to receiving support and mental health care services. The unexpected death by suicide and society’s general stigmatizing appraisal of the self-inflicted death can complicate the suicide loss survivor’s road to recovery and increase the risks for negative physical and mental health experiences. The perception of suicide will directly influence the grief experience and may impact the life of suicide loss survivors. Suicide loss survivors are at increased risk for suicide and often report the desire to take their own life. Methods: Twenty-eight participants (21 women and 7 men) shared their experiences during in-depth semi-structured telephone interviews in this qualitative descriptive study. Interviews were audio-recorded, transcribed verbatim, and content analyzed. Results: Participants conveyed their experiences before and after the loss by suicide. These categories emerged: Life before Suicide, Life after Suicide, and Meaning of life. By including experiences of male and rural participants’ suicide loss, findings fill previously identified research gaps.

Background: An emerging evidence base demonstrates that infants with single ventricle heart disease (SVHD) have increased survival rates, improving their long-term outcomes. A 15% mortality rate remains during the interstage period. Care coordination can impact survival in these infants which in some cases might be complicated by rurality, access to healthcare, and cultural difference. Theoretical Framework: Meleis' middle-range transition theory is the primary theory driving this study. Purpose: To explore the differences within clinical characteristics and mortality between rural and urban infants with SVHD during the interstage period. Through comparison of pre-existing data evaluating rural and non-rural infants with SVHD, the study identified outcome disparities within the following specific aims: To describe the pre-discharge sociodemographic, health status, and clinical characteristics associated with interstage mortality through secondary analysis of existing data of rural and non-rural infants through comparison of the infant's diagnosis, cardiopulmonary bypass times, extracorporeal membrane oxygenation (ECMO), baseline saturations, weight gain, and mode of feeding to interstage mortality. Aim 1 - Seattle Children’s dataset (SCH). Aim 2 - Pediatric Heart Network public datasets (PHN). Methods: A quantitative descriptive design, using secondary analysis of two existing datasets: SCH (2013-2017) and PHN (2005-2009). Findings: For the SCH data, there were 60 infants,45 survived, and 15 died. Of the 15 infants who died, 11 died after the Norwood procedure but before discharge home. Infants who required ECMO had a greater risk of dying. Birthweight and number of emergency room visits were protective, meaning those infants were more likely to survive. In the PHN data, of 281 infants, 227 survived, and 54 died. Of the 54 infants who died, 39 died after the Norwood procedure but before discharge home. A statistically significant greater risk of mortality was found

Purpose: The purpose of this quality improvement project was to assess the feasibility and usability of self-screening for risky substance use using the Oregon SBIRT app in a primary care setting. This project was conducted in the University of Arizona Telehealth Learning Center (TLC), a virtual clinic with professional participants.Background: Mobile health applications (mHealth apps) are gaining popularity in health management. Substance use interventions via mHealth improve access, especially for rural and underserved patients. Engagement with technology may reduce the stigma often reported with in-person exchanges. The Oregon SBIRT app is currently the only patient-facing app using the SBIRT method. Methods: TLC participants received an emailed disclosure form and link to a scheduled, recorded group Zoom session. After reviewing the project’s purpose, the SBIRT method, and the Oregon mHealth app, participants completed online surveys. Participants accessed the online Oregon SBIRT app using personal Internet-connected devices. Pseudonyms and fictional scenarios of substance use habits were used to protect privacy. Themes from subjective reports and validated measurements determined the feasibility and usability of the Oregon SBIRT app for self-screening in a primary care setting. Results: To be clinically feasible and useful, the Oregon SBIRT app requires a secure and easily accessible method to communicate app results. Participant feedback focused mainly on the challenges of managing multiple technologies in an online group setting. Conclusion: Quality improvement project design should not add unnecessary complexity or detract from the project's purpose. Remote videoconferencing may be inappropriate for trialing mHealth apps in a group but may be ideal for conducting focus groups.

Purpose: This quality improvement project was developed and implemented to increase knowledge and self-efficacy related to vaping behaviors for youth at Valle del Sol, an integrated outpatient community health organization in Phoenix metropolitan area. Background: The youth vaping epidemic has been a significant and growing public health problem over the past 10 years, which can lead to a variety of mental and physical health consequences. Educating youth on vaping can help them make informed health decisions. Methods: Youth aged 11-18 enrolled in Valle del Sol substance use or transition to young adulthood programs were recruited for participation in CDC’s Know the risks: A youth guide to e-cigarettes presentation. Demographic data on vaping behaviors was collected prior to intervention. Before and after intervention, vaping knowledge and perceptions of self-efficacy were assessed via survey data. Additionally, free response items were collected via survey data on perceptions of vaping self-efficacy and intervention satisfaction. Paired t-tests were utilized to assess knowledge and self-efficacy gained from vaping presentation. Results: 23 out of 28 participants completed pretest/posttest survey data. Baseline demographic data revealed that average age of participants was 15.8 years (range=13 to 18 years), with 61% male and 39% female participants. 57% of participants reported not vaping nicotine and 54% reported not vaping THC in past 30 days. Of participants who did report vaping in last 30 days, 25% reported vaping nicotine 20+ days per month and 21% reported vaping THC 0-10 days per month. Polysubstance use was reported by 14 out of 28 youth. Paired t-tests revealed vaping knowledge scores increased by 7.8 points (out of 100 possible; p = 0.06) and self-efficacy scores increased 0.6 points (with a range of 6 - 30 possible; p = 0.6). Approximately one half of participants (52%) increased vaping knowledge and self-efficacy. Although not statistically significant

Purpose: The purpose of this quality improvement (QI) project is to increase knowledge and self-efficacy of auricular acupuncture as an alternative therapy for chronic lower back pain, for health care team members in the integrative health clinic.Background: Since 1999, approximately 750,000 people in the United States have died from drug overdoses.The identification of alternative, nonopioid treatment strategies should be a high priority. Research into safer alternative pain management strategies such as auricular acupuncture could be a step toward reducing opioid prescribing for chronic lower back pain and, ultimately, toward reducing the prevalence of opioid dependency. Methods: The DNP project used a pretest–posttest survey design to analyze the integrative clinic health care team's knowledge and self-efficacy of auricular acupuncture as an alternative pain management modality for treating chronic lower back pain following an synchronous online educational activity. Results: Eight health care team members completed the educational training session. All participants completed all components of the intervention and survey. The results indicated no increase in knowledge of auricular acupuncture but an increase in perceived self-efficacy in recommending and trying auricular acupuncture for chronic lower back pain. Conclusion: The DNP project’s outcomes indicated that education on auricular acupuncture can improve health care team members’ perceived self-efficacy regarding recommending auricular acupuncture as an alternative treatment approach for chronic lower back pain.

Infertility affects 10% of women in the United States, making it an extremely common problem. Rates of anxiety and depression are found to be much higher in women dealing with infertility. Despite this education concerning stress, infertility, and stress reduction techniques are lacking in availability. The purpose of this project is to educate women dealing with infertility about the link between stress and infertility, as well as stress reduction techniques and intent to implement stress management techniques. Recruitment took place in Facebook infertility support group with women ages 18-50. They completed surveys in the RedCap system before and after viewing education materials in the form of a brochure and video explanation of the brochure. Educational materials including information about the relationship between stress and infertility, as well as specific examples of stress reduction techniques. Overall participants reported a minor increase in understanding concerning stress and infertility, and an increased intent to utilize stress management techniques of 20%. While this project was performed with a small sample the reported increased intent to use stress reduction techniques and desire for more information about stress and infertility show that the education materials could be revised and used for future research.

Purpose: The purpose of this quality improvement project was to evaluate the NeuroRestorative Nevada rehabilitation center staff members’ perceived effectiveness of a virtual reality activity (VRA) video game program for increased movement opportunities for patients, including post-stroke. Background: Approximately 800,000 adults in the United States suffer a stroke each year. Nearly half of stroke patients suffer from motor functioning problems, but only one out of three patients receive outpatient rehabilitation services. Patients are being forced to consider alternative available therapy options that will provide motor improvements. Virtual reality activity video game therapy is a novel cost-efficient treatment shown to improve motor rehabilitation and increase patient satisfaction. Though virtual reality activity video game therapy may not be a first-line treatment option, it can be a viable option for patients that cannot access traditional therapy. Methods: This quality improvement project evaluated the staff members’ perceived effectiveness by providing a virtual information meeting to the staff members, followed by participants completing the online post-meeting survey after one-week of engaging with the video game console. The project’s participants included ten staff members that voluntarily choose to attend the information meeting and complete the post-meeting survey. Results: Four participants completed the online post-meeting survey. One out of the four participants answered “Yes” to using the video game system during the one-week trial. The participants chose either “4 – Agree” or “5 – Strongly Agree” responses, with one “3 – Neutral” response, to the six Likert-scale survey questions that the video game console was easy to use, safe for patients with motor impairments, enjoyable to use, affordable and can be used in different settings, can increase patient movement, and would be utilized in the future. Conclusions: All participants agreed that a virtu

Purpose: The purpose of this quality improvement (QI) project was to increase mental health provider awareness concerning standardized youth suicide screening and implementation of the Suicide Behavior Questionnaire-Revised (SBQ-R) tool at Bayless Integrated Health. Background: Suicide is the second leading cause of death in young individuals ages 10-24. A suicide occurs every 20 seconds and 20 more youth attempted during that time. The Center for Disease Control and Prevention reported a 56% increase in suicide rates between 2007 to 2017 and a 7% annual increase in suicide among younger individuals. Methods: This QI project was a descriptive study on a quality improvement effort at an integrative health clinic in the Phoenix-Mesa area that serves the youth population. Mental health providers participated in a one-group pre-survey and post-survey design to measure any changes in knowledge pertaining to youth suicide and risk factors, and determination of provider willingness to adopt a youth suicide screening tool into practice. Principles of The Theory of Planned Behavior (TPB) were used to construct an evidence-based educational intervention on youth suicide, risk factors along with an introduction to the Suicide Behavior Questionnaire-Revised (SBQ-R) for recommended use in clinical practice. Results: 13 mental health providers participated in the QI project. All participating providers completed the pre-survey, viewed the evidence-based educational intervention and completed the post-survey. Overall, all providers rated their ability to identify youth suicide risks and screen for suicide as proficient. Participating providers shared favorable opinions regarding the adoption of a clinical screening tool, the Suicide Behavior Questionnaire-Revised in clinical practice. Conclusions: The introduction of the Suicide Behavior Questionnaire-Revised was easily understood and accepted by participating mental health providers. The study revealed providers are willing to ad

Purpose: The purpose was to find out if screening for obstructive sleep apnea in the primary care setting using a questionnaire increases referrals for further sleep studies. The goal was to increase the number of referrals for follow-up sleep studies. Background: Sleep apnea is a sleep and respiratory disorder that causes frequent wakings in the night due to the throat muscles collapsing and causing the person to wake up to get needed oxygen. This disorder affects more than 22 million Americans and has a 2.47 increased morbidity and mortality risk if left untreated. Studies show that as many as 1 in 5 individuals struggle with sleep disordered breathing and 80% of these disorders go undiagnosed. Untreated sleep apnea has been linked to cardiovascular disease, hypertension, diabetes, strokes, and depression. There is currently no routine screening for sleep apnea in the primary care setting, but literature shows screening with the STOP-BANG Questionnaire increases follow-up for sleep studies and earlier treatment. The STOP-BANG Questionnaire has better sensitivity and specificity compared to other tools tested. Methods: The STOP-BANG Questionnaire was implemented to screen overweight patients with hypertension within one primary care practice for one month and referrals for follow-up were compared to the one month prior. A positive screen was a score of 4 or higher on the questionnaire. The post-intervention total was compared to the pre-intervention total and success was shown if the number of referrals increased by more than 10%. Results: Prior to the intervention, the clinic referred and set up four patients for follow-up sleep studies. Post intervention, the clinic referred and set up eight patients for follow-up sleep studies. There was a 100% increase in referrals in the post intervention group. Out of 12 participants, 2 screened negative, 10 screened positive, 2 refused referral while 8 accepted the referral for follow-up. Conclusion: The use of the STOP-BANG

Purpose: The purpose of this quality improvement project was to assess health care providers’ knowledge of current adolescent depression screening guidelines and provide them with education regarding these guidelines to increase their screening frequency.Background: California’s adolescent depression percentage is above the national average and continues to increase. Current clinical guidelines suggest the routine screening of adolescent depression in primary care clinics during annual visits or when risk factors are identified; however, the number of depression screening performed by health care providers remains low, 34%. This lack of screening contributes to unidentified adolescent depression which can result in poor future health outcomes. Methods: This project was guided by the Model for Improvement by using a quantitative pre/posttest design along with an evidence-based Zoom video presentation about adolescent depression screening. Providers received an email with links to an anonymous pretest, posttest, and Zoom video, and were given two weeks to complete each of these steps. After the closing of the surveys, results were analyzed using descriptive statistics. Results: A total of two healthcare providers participated in this project. The data was collected over the course of two weeks. Both providers who participated reported an increased knowledge in the discussed adolescent depression screening guidelines, as well as an intent to implement those guidelines. Conclusions: A low participation rate was the greatest limitation for this project; however, the data provided by the participants indicated that providing providers with education on adolescent depression screening increases their comfort and knowledge level of the issue. Educating providers and increasing their intent to implement the guidelines are the first steps to closing the gap in adolescent depression screening in primary care.

In 2014, the global estimate of those with diabetes was 422 million (World Health Organization [WHO], 2018). The costs associated with the complications of diabetes can be detrimental to individuals and whole healthcare systems. Therefore, achieving glycemic control in diabetic patients is essential to improve patient outcomes and reduce complications. Glycemic control is assessed by testing hemoglobin A1C (HbA1C). Diabetic patients are tested anywhere from twice a year to quarterly, depending on HbA1C goals. Patient reminders and general education provided through text messages, short message services (SMS), and secure messages through patient portals have demonstrated improvements in HbA1C. Patient reminders and education varies. It includes anything from reminding the patient to take their medications to proper insulin injection techniques. Project purpose: increase diabetic patient follow up testing for HbA1C testing utilizing patient reminders sent through the patient portal. The project was developed with assistance from the Banner University South Campus Quality Improvement team in Tucson, Arizona. The nurse practitioners in this clinic identified five patients each. Patients were between the ages of 18 to 75 years old with an HbA1C of 9% or greater and due for testing. The patients received a reminder message through the patient portal system to return for follow up testing. A survey was provided to the nurse practitioners to assess their perceived usefulness of the patient portal. Descriptive statistics were used to analyze the findings. This quality improvement project will help determine if patient notification reminders help improve follow up testing in diabetic patients and ultimately improve patient outcomes. Results: Twelve patients received a reminder, and two made follow up appointments. Survey findings suggest a somewhat favorable approach to the use of the patient portal reminders.

Purpose: The purpose of this quality improvement project was to improve participants understanding of nutrition utilizing the American Diabetes Association guidelines and MyPlate mobile application at the Scottsdale/ Paradise Valley YMCA. Background: Approximately 30.3 million individuals have been diagnosed with diabetes in the United States This disease requires glucose monitoring, medication adjustments, and dietary management. The American Diabetes Association (ADA) has developed evidence-based guidelines on nutrition for individuals that have been diagnosed with diabetes. As technology advances, health care information has become easier to access on mobile devices. MyPlate is a mobile nutrition application that is recommended by the U.S. Department of Agriculture to educate children and adults about nutrition. Methods: A quality improvement project, including an educational intervention and a 5-point Likert-style pre-post questionnaire, was conducted at the Scottsdale/Paradise Valley YMCA to educate participants with diabetes about the ADA guidelines on nutrition and the MyPlate mobile tracker application. A power point, handouts, and dinner were used to educate the participants. Responses to the questionnaires were organized into four categories focusing on participants’ health literacy, nutrition, the ADA guidelines, and the MyPlate application. Results: There were six participants in this quality improvement project. The surveys utilized the 5-point Likert rating scale: improvement was determined by comparing the mean of the pre- and post-surveys. The two areas that demonstrated the greatest improvement were the individuals’ understanding of the ADA guidelines and MyPlate. Moderate improvement was seen in the participants understanding of nutrition and health literacy. Conclusion: The results of survey comparisons showed the participants’ understanding of health literacy, nutrition, ADA guidelines, and MyPlate all improved after the education session. All of

The specific aims of this study were to 1) determine the differences between rural and urban Latinas with breast cancer for psychosocial distress (depression and anxiety), symptoms and symptom management, social support, and health care use, and, 2) determine the relationships among depression, anxiety, symptom distress, symptom management, social support (emotional and informational) and health care use. Method: This descriptive study was a secondary data analysis of data from a randomized controlled trial (RCT) testing the effectiveness of telephone interpersonal counseling intervention compared to supportive health education for Latinas with breast cancer and their informal caregivers. Latinas were recruited throughout the Southwest and Florida. Sample: A total of 120 Latinas with breast cancer participated in this study and the data used was from the baseline assessment. Latinas with breast cancer were matched on stage of breast cancer, and divided based on rurality. Sixty participants were in the rural group and 60 were in the urban group. Results: Essentially, there were no significant differences between rural and urban Latina women for depression, anxiety, symptoms and symptom management, social support, and health care use. Although there were no significant differences between rural and urban Latinas for depression, the rates for depression were similar for both groups. Both groups experienced clinically significant depressive symptoms. Increased depression also increased anxiety and symptom distress, and decreased the ability to manage symptoms and perceptions of emotional and informational support. Conclusion: The findings were not consistent with previous research that rural Latinas suffer from higher rates of depression, anxiety, distress, and lack access to social support versus their urban counterparts. However, the rural and urban groups had similar rates of depression, anxiety, and global symptom distress. Therefore, affecting their ability to mana

An estimated 10-20% of women are diagnosed with post-partum depression (PPD) within their first year after childbirth. New mothers are currently taught essentials in caring for their newborn infants; little emphasis, however, is placed on signs and symptoms of post-partum depression. The purpose of this quality improvement project was designed to address the gap in patient education at hospital discharge and to increase referrals to outpatient behavioral health services, thus, improving patient outcomes. This quality improvement project investigated if postpartum women who received education regarding PPD detection at Mountain Vista Medical Center and those who were deemed at risk for PPD according to the Edinburg Postnatal Depression Scale (EPDS) received referrals for outpatient behavioral services from the nursing staff compared to the current standard of using half of the EPDS tool. This project was guided by the Nurse Communication Framework, and the Diffusion of Innovation Theory. The Plan, Do, Study, and Act quality improvement model helped to achieve the two specific aims of this quality improvement project: (1) provide an educational program for nursing staff to heighten their awareness of PPD and teach them how to administer the EPDS; (2) implement change in practice to have new mothers assessed for PPD risk using EPDS for 80% of the discharges. The use of the EPDS tool for discharge went from 50% to 85% exceeding the goal of this quality improvement project.

The objective of this quality improvement (QI) project was to educate African American patients diagnosed with hypertension about healthy dieting to improve blood pressure. The Joint National Committee (JNC 8) Hypertension Guidelines were referenced for this project. This project was implemented at Advanced Internal Medicine starting in September 2019 at an outpatient clinic in Stockbridge, GA under the supervision of Dr. Alicia Shelly. The PICOT question used to guide this project was: In African American (AA) adults, can dietary educational sessions about the DASH diet improve knowledge and confidence for blood pressure control? During the initial encounter, patients were given a pre-test to complete to assess their knowledge on hypertension and dieting and their readiness to change their diet. Patients were educated on healthy dietary intake for hypertension following the DASH diet recommendations and then given a post-test to evaluate the effectiveness of the initiative. The resources given to patients included an educational pamphlet, including information about the DASH diet, with a dietary food group table attached for reference. The hypothesis stated that the implementation of an educational program about healthy dieting in hypertensive AA patients would present a significant increase in knowledge and confidence level to modify their diet for blood pressure control. The results showed that participants had a significant increase in knowledge gain and confidence level following the educational intervention. This project is an example of a quasiexperimental design group study, pre-test/post-test. Keywords: African American (AA), hypertension, blood pressure, guidelines, DASH diet, outpatient.

Purpose: The purpose of this DNP project is to determine the efficacy of a mindful eating mobile application in decreasing unhealthy eating and binge eating habits, promoting healthy eating behaviors and increasing mindfulness during eating in college adult graduate students in the College of Nursing. Background: The collegiate population is known for developing unhealthy eating habits consisting of skipping meals, binge eating, and stress eating that can cause a negative impact in students’ health. Nurses have been identified at high risk for poor self-care, thus nursing students are an extremely vulnerable population. Mindful eating is an emerging practice that is effective in combatting eating disorders, binge eating symptoms, and weight loss. With the emergence of mobile health apps, and over 99% of college students utilizing health apps, a mindful eating mobile application intervention may be a solution in aiding students develop healthier eating habits. Methods: Following a review of mindful eating computer applications the Am I Hungry? mindful eating computer was chosen for its compatibility with mindful eating principles and ease of use. A baseline survey including demographics, mindful eating questionnaire (MEQ) and binge eating scale (BES) were given to participants prior to the introduction of the intervention. Participants utilized a mindful eating mobile application, Am I Hungry? for six weeks. Post-surveys were emailed at the end of six-week period assessing the MEQ and BES scores as well as questions evaluating frequency of use and perceived usefulness of the mobile app. Outcomes achieved: 38 students participated in the pre-survey and 24 students were retained completing the six-week intervention and responded to the post-survey. Surprisingly, 100% of all student participants BES scores >17 consistent with moderate binge eating behaviors and 54% student participants BES scores >27 consistent with severe binge eating behaviors. As anticipated there wa

An increasing number of minority individuals are seeking care in the healthcare industry. Patients whose second language is English often do not read or understand post-operative care materials. This is detrimental to recovery and increases the length of hospital stays. Incorporating clinical practice guidelines (CPG) for same-day rehabilitation into the preoperative education for Spanish speaking patients will facilitate patient understanding, and knowledge that patients cannot receive through information packets or in the education they are currently receiving. The purpose of this DNP project was to develop educational materials that are effective for a culturally diverse population of patients of Hispanic origin receiving total knee arthroplasty (TKA). The study question was: Does improving educational materials effectively increase minority patients’ understanding of post-operative care, thus resulting in shorter hospital stays? The Campinha-Bacote Model of Cultural competence guided this quality improvement project. This project had two phases. The first phase was to design the delivery of pre- and post-operative instruction through development of a pre- and post-operative educational product for Spanish-speaking TKA patients to engage in post-operative care activities. The second phase involved the training of nurses with the use of the educational product, as well as the delivery process for the pre- and post-operative educational product given to patients. The target population of this study was minority patients who underwent TKA surgery and were treated with accelerated rehabilitation post-operation. Chart reviews was used to collect date of discharge for patients given the instructions in Spanish. Feedback was obtained from the nurses and the patients on how to improve the educational material. The average length of stay was calculated for these patients and compared with previous length of stays for non-English speaking patients in a bar graph. Results i

Background: Opiate use has increased among pregnant women, thus causing an increase in newborns born with Neonatal Abstinence Syndrome (NAS), an opioid withdrawal syndrome that occurs in newborns following the delivery period. The rate of NAS newborns continues to rise in rural communities. The Mat-Su Borough in Alaska has the highest rate of NAS newborns, thus making it important that this population of providers is aware of developmental outcomes children may encounter. Purpose: The purpose of this DNP project was to develop and evaluate an evidence-based educational presentation on the potential developmental effects on NAS infants. This project required the development of an evidence-based presentation creation and the assessment of the knowledge gained by providers whom attended the presentation. Methods: This DNP project utilized a pre-test/post-test approach with an educational presentation to Pediatric Primary Care Providers at Ptarmigan Pediatrics in Wasilla, Alaska. There was a live presentation on September 10, 2018, which yielded three participants and a recorded presentation that yielded another two participants. Data analysis was accomplished by utilizing descriptive statistics. Results: There was a total of five participants, in which there was a 60%-80% correct answers on the pre-test. Following the presentation intervention, the post-test scores were 100% from all five providers. Discussion: The knowledge that was gained by providers during the presentation will greatly improve their care for children affected by NAS. Further research and dissemination should be considered and completed in order to care for this high risk population.

Purpose: The purpose of my project is to identify health care providers’ confidence and attitudes in addressing obesity and determine if asynchronous provider education including motivational interviewing (MI) is an effective tool in increasing providers’ confidence and attitude in addressing adult obesity in two primary care clinics in San Diego. Background: Obesity is associated with a significant risk for morbidity, mortality, and decreased quality of life. Current guidelines recommend primary care providers screen all adults for obesity and offer or refer obese patients to intensive counseling and multicomponent behavioral interventions. Despite clinical guidelines the crucial role of primary care providers in addressing rising trends in obesity, many providers fail to consistently adhere to obesity screening and management. MI a communication approach that may help providers overcome perceived barriers to addressing obesity with adult patients in the clinical setting. Methods: A 15-minute Likert scale pretest survey was electronically emailed to six providers in a primary care clinic. Details of the survey included: 1) Knowledge of MI and obesity management; 2) Attitudes associated with obesity; and 3) Perceived barriers to addressing obesity. All provider participants received an educational asynchronous PowerPoint focused on the use of MI to initiate obesity counseling and management. Following content viewing, provider participants were instructed to respond to a post-test survey identical to the pretest survey. Outcomes Achieved: Five primary care providers completed the pretest and posttest for a response rate of 75%. Participants include three nurse practitioners and two physicians. Overall and individual response scores improved in MI and obesity management knowledge. Overall attitudes towards obesity also showed improvement, however, individual attitude scores were inconsistent with responses ranging from improvement to unchanged or regressed. Consisten

Problem: Pregnant women are at an increased risk of harm from seasonal influenza and unvaccinated women have higher rates of influenza hospitalization and death (Centers for Disease Control and Prevention [CDC], 2017a). Influenza vaccination for pregnant women has been recommended by the CDC (2017a) for more than 30 years and passive immunity from the mother to fetus has been well documented. Despite the evidence, the literature identifies the largest barrier to vaccination is that pregnant women are not offered the vaccine during their antenatal course (Jung et al., 2016; Maher et al. 2013). Purpose: Guided by the conceptual framework of the Health Belief Model (Champion & Skinner, 2008), this project's purpose is to evaluate if an educational intervention on influenza and its risks, while dispelling common myths and misconceptions of influenza vaccines, would improve the rate of influenza vaccination at the Native American Health Center. Goal: The goal for this project is to improve provider knowledge and comfort with offering the influenza vaccine and that more pregnant women would be vaccinated during the following influenza season. Objective: The project’s primary objective is to develop and implement an online education intervention that would inform providers on the risks, benefits, cost, and safety of the influenza vaccine during pregnancy, while addressing barriers and misconceptions identified from the literature. Plan: Over a one-week period in July 2018, pre-and post-est surveys, as well as an online education module were sent to twenty-four physician and Advance Practice Providers at the Native American Health Center in Oakland California. Each participant’s pre-and posttest were compared after the intervention to evaluate how the module impacted their future practice regarding influenza vaccination to pregnant women. Results: The education module only slightly impacted provider identification of future vaccine practices and the change was not significa

Problem Statement: Unintended pregnancies (UP) are preventable life events that place both personal and societal strain accounting for approximately half of all pregnancies in the United States annually. Intrauterine devices (IUD) are highly effective forms of contraception that prevents UPs but are often underutilized due to several barriers including misconceptions about safety and efficacy, especially when considering adolescent women. Purpose: To describe contemporary use of IUD clinical practice guidelines (CPG) amongst various providers and to determine the effect of an evidence based educational intervention on perceptions and practice beliefs. Methods: Descriptive quantitative pretest posttest design with a brief educational intervention in the form of a PowerPoint presentation. All providers trained to counsel on and prescribe IUDs to adolescents within a large community health center in Tucson, Arizona were surveyed before and after the educational intervention to assess changes in perceptions and future practice patterns. Results: The provider responses indicate varying levels of limited provider knowledge related to selecting candidates, counseling on and prescribing IUDs to adolescent patients as dictated by current CPGs. The information also indicates that lack of knowledge may attribute to a perceived lack of confidence which may result in decreased numbers of IUDs being prescribed. Finally, post-education responses indicate a change in perceived self-efficacy and knowledge surrounding current CPG information. Significance: Targeted educational interventions for providers of contraception to adolescent patients positively affects adherence to evidence-based CPGs intended to reduce UP rates. Increased education also positively affects providers’ knowledge and perceived ability to safely counsel on and/or prescribe IUDs to nulliparous adolescents.

The purpose of this DNP project was to conduct a survey of persons with a mental illness to ascertain their experiences, good or bad, when seeking health care services. Persons with a mental health diagnosis have significantly higher rates of chronic diseases including hypertension, cardiovascular issues, diabetes, obesity, asthma, cancer, respiratory illnesses, and gastrointestinal problems, when compared to the general population without a mental health diagnosis. In addition, persons with a mental health diagnosis have higher rates of tobacco and alcohol abuse. Persons with a mental health diagnosis have a significantly higher premature mortality rate when compared to the general population without a mental health diagnosis. This gap is widening and needs to be mitigated to prevent further disparity in healthcare outcomes in this population. A needs assessment, designed as a quality improvement project, was been chosen to guide the methodology of the DNP project aims that include: 1) assess barriers to accessing primary care as described by patients with a mental illness using the structured PCAT survey tool, 2) analyze the findings from the survey and develop a plan to address the patient described barriers to accessing primary care, and 3) implement a corrective action based upon findings from the PCAT survey, to minimize barriers to primary care for persons with mental illness in this urban clinic setting. The participants (n=7) answered between 22 to 27 questions about their perceptions of care at their primary care clinic. A descriptive analysis of the data was performed to describe patient’s perceptions to four domains of care. Participants reported a perceived lack of access to someone in a timely manner as troublesome. This resulted in the participant’s report of apathy about their own wellness and management of acute or chronic illnesses. The lack of availability of their identified PCP resulted in participant’s acknowledgement that use of the emergency

Background: Lack of congruence between the Southeast Arizona Area Health Education Center (SEAHEC) objectives and components of the Health Professions Training Opportunities Program (HPTOP) program evaluation framework rendered successful program impact evaluation unfeasible. Objective: Alignment of the SEAHEC objectives with components of the HPTOP evaluation framework to create a comprehensive HPTOP evaluation tool. Design: Gap analysis. Setting: SEAHEC in Nogales, Arizona. Target: Two SEAHEC stakeholders, the SEAHEC executive director and the HPTOP project coordinator Interventions: Gap analysis and logic model were implemented using qualitative data gleaned from discussions with stakeholder, as guided by the Plan-Do-Study-Act framework. Brainstorming, thematic association between components of the HPTOP evaluation framework, and development of recommendations for a revised HPTOP evaluation tool and refined HPTOP evaluation framework based on gap analysis findings were executed in this quality improvement (QI) project. Results: The results were assessed thematically in terms of HPTOP program objectives, measures, activities, and expected outcomes.

Purpose: With heart disease as the leading cause of morbidity and the death rate of heart-related chronic diseases (including heart failure) increasing more each year in southern Nevada, the purpose of this quality improvement project is to assess if the healthcare providers from an outpatient clinic in southern Nevada have knowledge and/or barriers to screening or referral of patients with advanced heart failure (HF) to palliative care (PC). Background: The prevalence of HF is expected to increase by 46% from 2012 to 2030 and an estimated 5% of 23 million people have advanced HF (Mcllvennan & Allen, 2016; Ghashghaei et al., 2016). Because of the limited curative options for patients with advanced HF (e.g., heart transplant or mechanical ventricular assist devices), knowledge and referral to PC would provide relief of symptom burden including pain, depression and fatigue, and improve quality of life (QoL) for these patients and their families. Methods: Healthcare providers of the Healthcare Partners Nevada Cardiology were recruited as participants to respond to a survey regarding their knowledge and practice of incorporating PC concepts and to identify their perceived barriers for referral or consultation to PC services. Paper surveys were used to collect data and descriptive statistics was performed to analyze the data. Results: Of the 14 respondents, 100% were male and Doctors of Medicine, 57.1% were between the ages of 35 and 49 years old, 57.1% had more than 10 years of experience as a healthcare provider and 35.7% provides care to an estimated 30 to 50 patients with advanced HF in the outpatient setting. Majority of the respondents practice discussing with their patients about avoiding aggressive procedures that are associated with significant risks such as intubation or performing CPR (100%); discontinuing medications (e.g., ACEIs and beta-blockers) that can cause hypotension and fatigue; using low dose opioids and nitrates to provide symptom relief for dyspne

Purpose: With the obesity epidemic ever increasing, the purpose of this quality improvement project is to assess if Veteran’s Administration (VA) primary care providers have knowledge of and/or application barriers of the Veteran’s Administration/Department of Defense Clinical Practice Guideline for Screening and Management of Overweight and Obesity (SMOOG) in the VA primary care clinic in southern Arizona. Background: The prevalence of obesity seen in adults in the U.S. escalated from 15% to 34%, which is more than double from 1980 to 2008. Active military and Veterans obesity rates rose in similar fashion. The implementation of practice guidelines is critical to effective treatment to counteract the rising rates of overweight and obesity. Adherence to clinical practice guidelines often remains low causing an omission of therapies recommended in the guidelines. Methods: This quality improvement project used a descriptive methodology. Initially, SMOOG was evaluated using the AGREE II instrument. Next, a survey was administered to primary care providers to identify provider knowledge of and barriers to utilization of the SMOOG guidelines. Inclusion criteria for this study are: VA employed primary care provider and practicing primary care for at least 1 year. The 20-question survey measured providers’ knowledge and perceptions of their use of the VA/DoD SMOOG. Results: Evaluation using the AGREE II tool revealed the lowest possible quality scores observed in the Applicability domain. Based upon the results of the evaluation SMOOG is recommended for use with modifications specifically improving its applicability. Fifteen primary care providers participated in the survey. The results revealed that few primary care providers use SMOOG in clinical practice and barriers exist to implementation of SMOOG. Conclusions: Assessing providers’ knowledge, perceptions, and barriers to SMOOG provides insight towards the next steps in addressing the rising prevalence of obesity among

Objective Formulation of a clinical practice guideline (CPG) for the use of thromboprophylaxis (TP) in pediatric patients with a central venous catheter (CVC). Participants The development team consisted of five experts and a doctoral candidate acting as the primary author. Evidence The guideline was developed utilizing the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. A systematic review of the evidence was performed and evidence was graded using the American Academy of Pediatrics (2004) evidence classifications for CPG recommendations. An appraisal team evaluated the guideline quality utilizing the AGREE Plus platform rating the guideline as “highest quality.” Consensus Employing a modified Delphi methodology, members of the development team reviewed available evidence and voted on proposed Key Action Statements (KAS). Consensus is defined as 80% rating the KAS “usually appropriate.” Conclusion Five KAS are included in the final CPG. Each KAS indicates level of evidence, benefit-harm relationship, and level of recommendation. KAS 1. Providers of hospitalized children (0-18 years of age) may assess for VTE risk factors using the Skrocki VTE risk stratification tool if the patient has a CVC. (Evidence Quality:C, Rec. Strength: Option). KAS 2. Providers of hospitalized children should initiate targeted pharmacologic thromboprophylaxis (tpTP) at the time of CVC insertion or hospital admission (if CVC present on admission). (Evidence Quality: B, Rec. Strength: Strong Recommendation) KAS 3. Providers of hospitalized children with a CVC should implement mechanical thromboprophylaxis (mTP) if the child is immobile (Braden Q score <2) or moderate/ high risk for VTE using the Skrocki VTE risk stratification tool and have no contraindications to mTP. (Evidence Quality: B, Rec. Strength: Recommendation). KAS 4. Providers of hospitalized children with a CVC may prescribe systemic pharmacologic thromboprophylaxis (spTP) if the patient is found to be

Background: Chronic disease is a growing problem in the United States and in Wyoming. It is associated with increased costs and increased morbidity and mortality. Technologies such as patient health portals have been shown to improve patient outcomes. Objective: The objective is to promote future use of the patient portal as a tool to improve chronic disease management by identifying opportunities to increase their use. Design: Using quantitative methodology, a 38-item survey was created to examine primary care providers' preexisting knowledge, attitudes, practice facilitators and barriers about patient portal use and chronic disease management. Setting: A nurse owned primary care clinic in central Wyoming Participants: Four nurse practitioners. Measurements: The survey responses and Likert-type questions, analyzed the mode and open-ended questions analyzed through content analysis. Results: The providers demonstrated an understanding of the benefits of patient portal use and its functions. It was found that although participants felt that their patients could benefit from this technology the portals were not used to their full extent. Conclusion: Health care technology has provided practitioners with the ability to improve patient outcomes. Strengthening the use of patient portals and increasing the quality of how they are used has the potential to enhance patient engagement in their care, ultimately improving patient outcomes.