Nursing Doctoral Work

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Skin Cancer Prevention in North Dakota Farmers and Ranchers
(North Dakota State University, 2013) Stensgard, Kathryn Marie
It is widely known that skin cancer is a significant health concern. Studies show that farmers and ranchers are at increased risk of skin cancer, presumed to be secondary to the increased time they spend outdoors and their increased exposure to the sun. This study examined the current sun protection techniques utilized by a sample of North Dakota individuals, who spend the majority of their occupational time outdoors. After collecting information reflecting demographics and current sun protection measures practiced by the sample, educational material focusing on skin cancer prevention and healthy sun behaviors was distributed to the individuals and the primary researcher gave an educational power-point presentation. A post-survey was then given to the sample, identifying the effectiveness of the education, as well as the intentions of the individuals to change. It was found that 74% of participants had never received previous instruction on sunscreen use. The computed odds ratio showed that the intent of participants to observe sunscreen use after the presentation was 3.47 times than before. An encouraging 88% of the participants reported increased intent to complete a self-skin examination post-intervention. The research showed areas for improvement from numerous aspects, including provider and patient education, encouraging preventative techniques while working outdoors, and encouraging regular self-skin examinations. The findings support the importance and effectiveness of verbal communication of health care providers in the family practice setting to verbally discuss skin cancer and sun protection behaviors with their patients, as well as provide patients with written educational information. By identifying the benefits, barriers, and intent of the participants to change, interventions may be implemented.
Medical Respite Care for Fargo-Moorhead Homeless Population: A Needs Assessment
(North Dakota State University, 2013) Hauff, Alicia Joy
Homelessness continues to increase in the Fargo-Moorhead community, and little is known about the health needs of its chronically homeless population. An informal needs assessment completed in 2010 gathered feedback from several key informants with experience working with the homeless population. Informants cited a variety of unmet health needs and barriers to access of appropriate health care services, and the priority need voiced was for a medical respite program. The purpose of this project was to conduct a formal health needs assessment of the Fargo-Moorhead homeless population to describe and document health needs from consumers' and service providers' perspectives, assess current community resources, and involve stakeholders in program planning as appropriate. The specific need for a medical respite care program was also evaluated, based on informants' feedback in 2010. Data collection methods included written surveys and semi-structured interviews. Consumers' priority needs were to secure a source of income and housing. Many consumers reported untreated physical or mental conditions, but primary needs were dental care and means to afford health care. Most consumers reported lack of health insurance and transportation as barriers to health care access. Lack of trust and experiences of disrespectful care were also reported. Service providers recognized many of the same needs, but also reported needs for treatment of co-occurring physical or mental illness and chemical dependency. Appropriate levels of care were also a concern, and many service providers discussed the need for a lower level of supervised medical care for shelter residents and homeless persons discharged from hospital care. Service providers cited many of the same barriers that consumers reported, and recognized homeless persons' inability to prioritize care above basic needs or manage care while homeless. Homeless Health Services and Family HealthCare in Fargo, ND remain primary resources for health care, and many consumers reported receiving care at these clinics as a regular source of care. Service providers reported frequent collaboration with both clinics, among other supportive services. However, the need for a medical respite program in the community was established. Recommendations for program planning address this and other needs.
Assessment of Obese Children within a Family-Based Intervention Pilot Study
(North Dakota State University, 2013) Agnello, Kelly Shannon
About one third of children in the United States are overweight or obese. Multiple comorbidities coincide with obesity affecting children physically and emotionally, which in turn impacts obese children’s quality of life. Despite the increased prevalence and negative consequences of pediatric obesity, few evidence-based practice or generalizable assessment tools exist. The purpose of this project is to transition a generalizable, evidence-based pediatric obesity assessment tool from research into practice in a local pediatric obesity program which can later be utilized in primary care in order to implement early intervention with obese children. The pediatric obesity specific quality of life measurements for children and their parents, “Sizing Me Up” and “Sizing Them Up,” were presented to two providers with clinical expertise from a local family-based obesity intervention outpatient program. These specific measurements, along with height, weight, BMI, and readiness for change assessment, were utilized by the providers at the beginning and end of the 10-week program consisting of 10 families. Evaluation of the assessment tool was conducted through a Likert Scale survey of the providers to determine the utilization, ease, and difficulty of use of the pediatric obesity assessment tool. The providers evaluated the tool as having quality utilization, good clinical battery, and ease of implementation. Therefore the tool is ready for implementation into primary care. By transitioning an evidence-based pediatric obesity assessment tool from research into practice, advanced practice nurses will be able to more accurately and fully assess obese children so that interventions can be implemented expeditiously.
Screening and Brief Interventions for Alcohol Use in College Students
(North Dakota State University, 2013) Dolalie Kelsch, Angela Ann
College students are recognized as a high-risk group for alcohol problems in the United States. Annually approximately 500,000 college students are unintentionally injured, and more than 1,700 college students die from alcohol-related unintentional injury. In addition, individuals who begin drinking alcohol early in life increase their risk of developing serious alcohol problems later in life. As a result, it is essential that efforts be made to focus on opportunities for alcohol screening and brief intervention where applicable in an attempt to reduce problem drinking behaviors. Alcohol screening and brief interventions for alcohol misuse is an effective way for health care professionals' at student health clinics to take advantage of screening a high-risk population for alcohol misuse during a routine clinic exam. The purpose of this practice improvement project was for healthcare providers to initiate alcohol screening on all willing patients via a self-administered alcohol questionnaire (Alcohol Use Disorder Identification Test) and for the healthcare providers to address problem drinking behaviors with individual patients where indicated by implementing a 5-15 minute brief intervention for problem alcohol consumption. The aim was that the screening would flag problem drinkers and at risk individuals who would benefit from a brief alcohol intervention and potentially avoid future alcohol related harm to their health. The AUDIT screening did flag problem alcohol behaviors and facilitated an opportunity for healthcare providers to discuss those negative alcohol behaviors as well as the negative long-term implications they can have on the lives of the individual college students.
�I Am Aids�: Bridging the Gap
(North Dakota State University, 2013) Brewster, Leah Marie
It is estimated that between 252,000 and 312,000 people in the United States are unaware that they are infected with HIV/AIDS and are unaware of their risk for HIV/AIDS transmission to other people (Morbidity and Mortality Weekly, 2003). Placed near the bottom in incidence for HIV/AIDS prevalence rates in the United States, North Dakota has 227 HIV/AIDS (North Dakota Department of Health, 2011). With low prevalence rates, a lack of cohesive healthcare provider groups is a challenge due to low demands for care. The purpose of this project was to identify the needs of persons newly diagnosed with HIV/AIDS and services available to address their needs in the Fargo, ND region. Bridging the gaps between where patients go from the point of diagnosis to the next step in care is where there are fragmented services that could be addressed by an established coordination of HIV/AIDS-related services in the state of North Dakota. Six individuals living with HIV/AIDS within the Fargo community were interviewed for stage one of this project. For stage two of this project, three key informants who specialize in the care of HIV/AIDS patients were identified within the Fargo community and interviewed. Data results from the HIV/AIDS-positive patients as well as the key informants supported the literature that there are gaps within the healthcare system, such as a lack of HIV/AIDS case managers to help patients coordinate and facilitate their care. An HIV/AIDS care quick reference guide was developed to identify the services available and those recommended to bridge the care gap in Fargo, ND. This practice improvement project has the potential to improve healthcare practice by providing practitioners with a resource guide on managing care for individuals living with HIV/AIDS.
Cultural Awareness and Provider Based Care for Refugee Women
(North Dakota State University, 2013) Middlestead, Andrea Jean
This disquisitional aimed to improve the cultural education of nurse practitioner's (NP's) related to female refugee populations. The ultimate goal was to improve health care outcomes and decrease disparities for refugee women by focusing on increasing cultural understanding, enhancing education, and providing a framework which NP's can utilize in daily practice. An online educational module was created and offered on the American Association of Nurse Practitioners Continuing Education website. Traditional cultural health care practices for the top 10 refugee populations in the United States in 2011 were compiled, compared with current cultural competence and awareness of primary care providers and formulated into an educational module. A 1.25 hour long PowerPoint accompanied by audio, pretest, posttest, and evaluation were created for members of the American Association of Nurse Practitioners. Participants were able to receive 1.25 continuing education units upon completion of the entire module and evaluation. Purposes from the educational module evaluation questions included: (a) perceived educational preparation during graduate education and at the postgraduate level, and (b) the perceived effectiveness of the educational method. Both purposes were supported through NP evaluation responses (n=85). There was a lack of graduate education on cultural awareness and implementation into practice found in literature. The evaluation results from this project conflicted with the literature by demonstrating 90% of participants felt adequately prepared during graduate education. The majority (94%) of respondents specified that the module "completely" or "quite a bit" promoted learning for each participant free of commercial bias. Educational modules using PowerPoint with audio appeared to be an acceptable educational strategy for NPs regarding cultural awareness based on survey evaluation data. As the culture of the patient population within the United States continues to evolve and change, it is of vital importance that NPs stay up to date on current practice and treatment changes that are culturally appropriate and sensitive. An educational framework to maintain cultural awareness, enhance understanding, and increase communication becomes a forefront issue. In order to assist with the coordination of care in the hopes to diminish health care related disparities, continued research is needed in the delivery of educational modules.
Implementing an Evidence-Based Oral Health Assessment Tool (OHAT) in a Nursing Home
(North Dakota State University, 2013) Nyongesa, Nancy Nekesa
Literature substantiates that there is a relationship between poor oral health and cardiovascular risk, uncontrolled diabetes, aspiration pneumonia, poor nutritional status, and poor social life for the older adults, especially those residing in nursing homes. Recognizing the impact of poor oral health and putting protocols in place to improve oral health status is a safe and cost effective intervention. This Practice Improvement Project (PIP) introduces and pilots a regular oral health assessment system into the care of residents in the nursing home. Four study questions were posed. These questions were: 1) how does an education intervention on the "Importance of Oral Health" increase nursing staff's knowledge of oral health in the elderly; 2) what impact does the use of Oral Health Assessment Tool (OHAT) have on resident assessment, documentation, and referral; 3) what are nursing staff and nurse practitioners' (NP) views of OHAT in assessing a resident's oral health status; 4) How does the brochure "My Mouth is Part and Parcel of My Health" impact the willingness of families to seek dental services for their loved ones living in the nursing home? This project was conducted in four phases. These phases were; 1) introduction of (OHAT) to nurse practitioners, nurses, and resident assistants and educating family members and nursing staff about the importance of oral health; 2) use OHAT for three months to assess oral health status of residents; 3) chart reviews to answer question two; and 4) survey nursing staff about their perceptions of OHAT. A comparison of pre-test versus post-test indicated improved knowledge (p-value <0.0001). During the three-month implementation, there was noted to be more documentation in residents’ charts in relation to oral health. Nursing staff viewed OHAT as an efficient tool to use. In addition, the NP was willing to prescribe OHAT in the nursing home for nursing staff to use. This project highlights that health care providers are willing to learn ways of improving care for residents in nursing homes. The findings support existing literature that increased knowledge about evidenced-based best practices is a factor in better oral health.
Assessing North Dakota Nurse Practitioners' Knowledge of the National Comprehensive Cancer Network's Treatment Guidelines for Adult Cancer Pain
(North Dakota State University, 2013) Schoenberg, Lisa Maire
The purpose of this project was to determine if access to the National Comprehensive Cancer Network's guidelines on the treatment of adult cancer related pain increased nurse practitioner knowledge and utilization in practice. The guidelines were provided to nurse practitioners who practiced within an oncology setting in North Dakota to assess whether their knowledge of pain management increased and if they found the guidelines to be a useful tool to have in practice. A pre-intervention questionnaire was sent to the participants to gain demographic information, including, age and gender, type of certification, primary area of practice, number of years practicing as an nurse practitioner, hours spent in clinical practice per week, and the average number of oncology patients seen per week. In addition, the pre-intervention questionnaire evaluated current treatment modalities the participants utilized in treating cancer related pain. After receiving the pre-intervention questionnaires, the National Comprehensive Cancer Network's guidelines were distributed to the participants who agreed to utilize them for the duration of this project. The participants were given the full guidelines, a pocketbook of the guideline's algorithms, and instructions for utilizing the phone application of the guidelines. A post-intervention questionnaire was sent out three months after the guidelines were distributed assessing their impact on nurse practitioner practice. Overall, the participants felt that the guidelines increased their knowledge on treatment modalities for cancer related pain and found them to be a useful resource in practice. From this project we can assume that the evidence based guidelines provided from the National Comprehensive Cancer Network are beneficial for novice and experienced nurse practitioners practicing in oncology.
Development of Prenatal Educational Library in the Somali Language for Family Healthcare
(North Dakota State University, 2014) Garrett, Karon Joyce
The purpose of the project was to develop a library of culturally sensitive, and language specific prenatal educational materials for Somali women at Family HealthCare (FHC). The educational materials were provided in both written and DVD form. The assumption being that culturally sensitive, prenatal education is necessary to promote knowledge and understanding in patients and increase engagement of healthcare providers. Prior to language specific resources, Somali women typically refused written informational resources. Somali women when offered culturally sensitive education materials readily accepted the information. The resources used were acquired from various governments and non-profit organization websites. In the course of the project, a library was developed which included educational materials from various government websites, non-profit organizations, Mayo Clinic and the MedlinePlus website. The beginnings of a prenatal education library at FHC was established by access to and selection of appropriate resources from MedlinePlus. The Cass County Public Health nurse will maintain and store the educational resources.
Development of an Algorithm for Adolescent Bariatric Surgery
(North Dakota State University, 2014) Roller, Nichole
Childhood obesity has become a national epidemic and children are diagnosed with co-morbidities once only associated with adults. Despite current interventions, children continue to exude poor diet and physical activity outcomes. The final project is an adolescent weight management algorithm to include bariatric surgery for select adolescents who meet the criteria. The algorithm developed was in congruence with a regional healthcare facility mission and goals. A literature review was conducted by searching databases EBSCO, CINAHL, Bing, Google Scholar and Academic Search Premier. The algorithm was developed by reviewing current literature and evidence on adolescent bariatric surgery. Experts in the field of adolescent bariatric surgery were contacted to evaluate the proposed algorithm. The development of an adolescent bariatric surgery program poses many challenges as it remains a relatively new process. The screening adolescents undergo before surgery is extensive and takes several months to complete. The algorithm may be helpful in the development of an adolescent bariatric surgery program and in the primary care setting as it can guide providers in the adolescent weight management process. The algorithm and the recommendations may be used as a starting point for program development and adolescent weight management, but the ultimate decision on which adolescents have surgery should be based on expert medical and surgical personnel judgment.
Implementing Clinical Practice Guidelines in Family Practice: Caring for Children with ADHD
(North Dakota State University, 2014) Nupdal, Jason Bentley
The purpose of this Practice Improvement Project was to promote evidence-based practice in caring for children ages 4-18 with Attention Deficit Hyperactivity Disorder (ADHD) in the family practice setting. The American Academy of Pediatric Clinical Practice Guidelines (CPG) and the Diagnostic and Statistical Manual of Mental Health Conditions, 5th Ed. (DSM-V) diagnostic criteria for ADHD were embedded in the electronic health record (EHR) in the form of an evaluation tool/template to guide the Primary Care Providers (PCPs) in documenting evidence-based practice in the assessment, diagnosis and treatment of ADHD. Primary stakeholders are PCPs of Riverview Clinic who care for children with ADHD. Neuman’s System Theoretical framework was used assuring a comprehensive holistic approach to caring for children with ADHD. The logic model was applied to direct project process while providing a framework for project evaluation. A focused forum was held to educate PCPs on the American Academy of Pediatrics (AAP) CPG and the DSM-V ADHD diagnostic criteria. PCPs were introduced to the tool with instruction on use. Six weeks post launching, a retrospective chart audit was done to evaluate for the presence of evidence basedpractice documentation with the evaluation tool/template versus without. When utilized, the evaluation tool/template demonstrates a higher rate of documentation supportive of evidence-based practice. The tool enhances provider’s comfort level in caring for children with ADHD while promoting optimal quality outcome for the child. Project outcome suggests the tool be used by PCPs in documenting evidence-based practice. Key words: ADHD, children, management, EHR, template, co-morbid conditions, and clinical practice guidelines.
Primary Care Resource and Referral Guide for Children 4-11 Years of Age with ADHD
(North Dakota State University, 2014) Jenzen, Bonita Jo
The practice-improvement project (PIP) assessed five family nurse practitioners and one pediatrician regarding the use and evaluation of a community treatment guideline packet. Attention deficit hyperactivity disorder (ADHD) is a commonly diagnosed, chronic, neurobehavioral disorder, and high-quality, evidence-based management is associated with improved outcomes. Research has shown an increase in the diagnosis rate for ADHD, and the need for intensified clinical management of children, 4-11 years of age, with ADHD. Without proper evaluation or management of ADHD symptoms, the child may continue to struggle throughout life. Family nurse practitioners (FNPs) employed in rural communities may be the first point of contact for children, 4-11 years of age, who present with ADHD symptoms. Providers need to be knowledgeable about ADHD, the treatment guidelines, community resources, and the proper referrals within the community. The PIP was designed to assist providers in 5 Minnesota communities who see 4-11 yearold children with ADHD symptoms. The PIP design included the creation and presentation of a treatment-guideline packet for 5 FNPs and 1 pediatrician in the rural communities. The providers volunteered to utilize and evaluate the packet for 6 weeks in January and February, 2014. To evaluate the treatment-guideline packet, a post-questionnaire was completed by each provider who participated. The practice improvement project results indicated that 100% (n=6) of the providers felt that the treatment-guideline packet was helpful and would benefit practice. Providers felt the packet addressed a practice need by containing both a community resource/referral algorithm and an evidence-based ADHD process-of-care algorithm. Three-fourths of the providers felt that using the Vanderbilt Assessment Scales for diagnosing children would be a helpful addition to iv the packet to assist with diagnosing ADHD in children of this age group. Overall, providers felt that being more aware of the potential referrals and resources in the community would allow a multi-modal approach of care, therefore improving their management of children, ages 4-11, with ADHD.
Implementation of the Alcohol Use Disorders Identification Test to Improve Practice in a Rural Primary Care Clinic
(North Dakota State University, 2014) Thompson, Kayla Joy
The purpose of the project was to improve patient care and the clinical practice at the Barnesville Area Clinic (BAC) by introducing the providers to a guided method of evidence-based alcohol screening and brief intervention (SBI) for primary care patients. Previously, less formal methods for alcohol screening were utilized. The AUDIT with AUDIT-C modification screening form, which was created by the World Health Organization (WHO), was implemented. AUDIT is supported as an appropriate evidence-based method by the U.S. Preventative Services Task Force. Interventions were guided by the WHO's Brief Intervention Manual. The project was implemented in the Barnesville Area Clinic from June 2013 until August 2013. Thirty adult primary care patients, who presented for an annual physical exam, were offered the AUDIT screening form and brief intervention as indicated by individual scores. Of the 30 patients, six declined participation. Five participants filled out the screening tool, but did not complete the attached consent form. The remaining 19 participants completed the screening tool and consent form. Seventeen patients scored within Zone 1 (low risk) and two patients scored in Zone 2 (increased risk for alcohol misuse). No one scored in Zone 3 (high risk) or Zone 4 (alcohol dependence). The providers were surveyed on the perceived benefits and barriers of the project. Both providers strongly agreed the project was beneficial and the methods were easy to use. The impact on patient care varied, depending on individual results and willingness to participate in brief interventions. Barriers included suspected under-reporting of alcohol use, and patient resistance to discussing alcohol use. Despite the barriers, both providers felt that SBI methods could be utilized by the clinic in future practice. Recommendations for future research include offering SBI to broader patient populations at provider discretion to include not only annual physicals but those with suspected substance use on an episodic basis. Another recommendation is to seek out research on screening and brief intervention or to develop a method of SBI for prescription abuse.
Development of Interprofessional Education Modules for Implementation into the Doctor of Nursing Practice Curriculum
(North Dakota State University, 2014) Huot, Ashley Grace
In today’s health care system, professionals must work together to achieve a common goal of improving patient care. Studies have shown that patients and families report lack of care coordination that result in repeat tests and procedures, unnecessary hospitalizations and difficult transitions from hospitals to home (Reinhard & Hassmiller, 2010). Interprofessional education (IPE) is an important approach for preparing health professional students to provide care that is patient centered and based in a collaborative team environment. Interprofessional education “occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (World Health Organization, 2010). The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional team behaviors to carry into clinical practice (Buring et al., 2009). Nurse practitioners will need to be equipped with the proper educational tools to work in a collaborative setting (Reinhard & Hassmiller, 2010). Current nursing education standards include requirements for interprofessional collaboration at the doctoral level of education (QSEN, 2012). The current Doctor of Nursing Practice (DNP) curriculum at NDSU has no specific objectives that focus on IPE and the AACN DNP essential competencies. The purpose of the project was to influence curricular change at NDSU to include IPE in the graduate nursing program. To meet that goal, three educational modules were developed based on core competencies of IPE. The titles of the modules were “Introduction to Interprofessional Education,” “Interprofessional Communication” and “Patient Safety and Improving Quality in Health Care.” The project was presented to the DNP faculty at NDSU to disseminate the findings and prove IPE’s importance for DNP students. The modules were reviewed by IPE experts from local universities with overall positive feedback. Several recommendations for improvement were provided to strengthen the content within the modules. Overall, there is a convincing need for the integration of interprofessional education into graduate nursing programs. The developed modules are a beginning to the process of integrating IPE into the DNP program at NDSU and will serve as a foundation to build on in coming months and years.
Improving Care for Depression as Provided in the Family Practice Setting
(North Dakota State University, 2014) Carroll, Robbie Joe
This Dissertation is a synthesis of current literature and guidelines to develop the Simplified Prescribing Tool. The Simplified Prescribing Tool provides a guide to treating depression within the Family Practice discipline. The tool contains information that focuses on correctly diagnosing depression and the severity of the depression. The tool provides general guidelines for pharmacological treatment and an algorithm created by the author. The algorithm guides the provider through the process of prescribing. Finally, the tool also includes information on the management of depression throughout treatment until remission of the depression or referral onto a psychiatric care specialist. The main focus was pharmacological treatment; however, the tool also included non-pharmacological consideration for treatment of depression. Data on the applicability of the synthesized tool were gathered by first surveying a group of psychiatric professionals for accuracy of the content contained in the tool. The second step in evaluation of the tool was to survey a group of practicing providers; the group included nurse practitioners, physicians, and physician assistants. This final step was carried out to fulfill the main goal of the paper, namely to see if the tool’s content was accurate and if the layout of the tool would lead to use in practice. After surveying the opinions of primary care practitioners, the data were grouped based on flow of the tool, the accuracy of the content, and applicability to practice. The general consensus was that primary care practitioners could readily use the Simplified Prescribing Tool in practice. This was seen as both a successful development of Simplified Prescribing Tool and as an indication for further research into this type of treatment modality.
Evaluating an Evidence-Based Prevention Program Delivered by Primary-Care Providers and In-Home Nurse Visits: The Period of Purple Crying, an Abusive Head-Trauma Prevention Program
(North Dakota State University, 2014) Stout, Jenna Rae
Shaken Baby Syndrome (SBS) is an abusive head injury where an infant is submitted to severe, repetitive acceleration-deceleration forces with or without blunt impact to the head (Centers for Disease Control and Prevention, 2012). Thirteen to thirty percent of infants diagnosed with abusive head trauma die as a result of their injuries (Dart, 2009). Fifty to ninety percent of survivors are left with varying degrees of disabilities (Reece, 2008). The purpose of the dissertation was to increase knowledge about SBS and to help prevent future occurrences. A family medicine clinic in rural North Dakota and the Nurse Family Partnership of Cass County, ND, participated in the project. The Period of PURPLE Crying, an SBS prevention campaign, was utilized to educate infant caregivers, as well as the registered nurses and family nurse practitioners delivering the education. The program utilizes a 10-minute DVD and a pamphlet to deliver the education. The acronym PURPLE describes the normal characteristics of infant crying. The education stresses how frustrating infant crying can be. The caregivers learn ways to console an infant, ways for the caregiver to stay calm, and how dangerous it is to shake an infant. The targets of the evaluation were infant caregivers and the healthcare providers implementing the education. Pre-surveys utilizing a Likert scale and four short-listing questions assessed infant caregivers' knowledge and beliefs about SBS. A post-survey utilizing the same questions was then used to assess any changes in knowledge and beliefs about SBS. The infant caregivers also showed an understanding about how dangerous shaking can be. The healthcare providers' knowledge and current practices for educating about SBS were evaluated with a free-response pre-survey. After three months of project implementation, a post-survey assessed what the providers had learned and how they felt about the educational tool, again utilizing free-response questions. The majority of the healthcare providers' feedback was positive in relation to their experience implementing the program. Increased knowledge about normal infant crying patterns among both the infant caregivers and the healthcare providers resulted upon intervention completion. The Period of PURPLE Crying is a sound curriculum to provide SBS prevention education.
Designing a Hypertension Management Program for Family Healthcare
(North Dakota State University, 2014) Danielson, Danielle Marie
The purpose of the practice improvement project was to determine the hypertension management needs of the Family HealthCare (FHC) clinic in Fargo, ND by staff interviews, observation, and data review as well as to develop a hypertension management program to meet those needs. The clinic’s needs and barriers regarding hypertension patients were identified and addressed in the newly proposed hypertension management program. FHC did not have a structured hypertension management program. The main barriers identified included poor patient follow-up, limited patient educational materials on hypertension, and ineffective patient flow. The program was developed based on the U.S. Department of Health and Human Services Health Resources and Services Administration’s hypertension control program. Items addressed in the program were correct blood-pressure taking techniques, evidence-based guidelines regarding patients with hypertension, hypertension tools for providers, education for providers and patients, and follow-up recommendations. The hypertension management program is to be managed by a quality improvement (QI) team that consists of providers, nurses, pharmacists, dietitians, health coaches, receptionists, and schedulers. The QI team will be responsible for evaluating the progress of the program using FHC’s Uniform Data Set report. The goal is to increase hypertension control (patients with a blood pressure of less than 140/90) to 70%. The hypertension program and recommendations were presented to the clinic director Dr. Espejo. The goal was for FHC staff members to recognize the benefits of the hypertension management program and for them to decide to try to implement the program at their facility.
Creation of Continuing Education Modules Addressing Leadership Development Components Applicable to Nurse Practitioners in the State of North Dakota
(North Dakota State University, 2014) Johnson, Amanda Rochelle
Effective leadership skills are a necessary element of successful Nurse Practitioner practice. Lack of leadership ability among Nurse Practitioners may lead to gaps in patient care, poorer outcomes, decreased patient satisfaction, increased healthcare spending, and inadequate communication between patients, providers, and peers (O’Grady, 2008). Both the National Organization of Nurse Practitioner Faculties (NONPF) and the American Association of Colleges of Nursing (AACN) identify components of leadership that are crucial to the role that the Nurse Practitioner plays while caring for patients (NONPF, 2012 & AACN, 2006). The landmark report on the Future of Nursing from the Institution of Medicine of the National Academies specifically identifies recommendations that directly relate to leadership, including the recommendations to “expand opportunities for nurses to lead and diffuse collaborative improvement efforts” and “prepare and enable nurses to lead change to advance health” (Institute of Medicine, 2010). A survey of Advanced Practice Registered Nurses was completed in the state of North Dakota (N=34) in an effort to identify areas of needed enhancement of leadership skills. Overall, participants identified four main topics that were felt to be lacking in proficiency in their current practice. These areas included involvement in health policy, systems leadership, negotiation, and influencing peers to accomplish positive change in practice. After extensive literature review, it was determined that information regarding these topics would be beneficial for nurse practitioners throughout the country. In response to the need for increased education regarding the aforementioned topics, a series of four online continuing education modules were created in collaboration with the iv American Association of Nurse Practitioners (AANP) Continuing Education Center and presented as a leadership development series. Nurse practitioners who completed the continuing education modules were surveyed regarding perceived knowledge and likelihood of involvement in the given leadership activity, and information regarding the electronic format of content dissemination was collected. Sample sizes ranged from 11 to 27 participants. Data collection occurred from May 16, 2014 to June 23, 2014. Evaluation of the modules demonstrated that participants indicated an increase in their perceived knowledge and likelihood of participating in the four areas of leadership. The vast majority of respondents indicated the modules were created at an educational level appropriate for their current role. Nearly every participant identified that the online module format is an effective means of content dissemination. Qualitative responses regarding the modules were generally positive in nature.
Improving Adolescent Friendly Healthcare Services: Implementing Comprehensive Psychosocial Histories into Practice
(North Dakota State University, 2014) Anderson, Melinda Kay
Adolescence is a unique period of rapid physical and psychosocial growth and development. Adolescents are most often physically healthy, but as a normal part of adolescent development the population commonly experiments with risky behaviors, which may lead to the development of unhealthy habits (National Research Council and Institute of Medicine [NRC/IOM], 2009). Additionally, risky behaviors are connected to the top three causes of potentially preventable adolescent death – accidents/unintentional injury, homicide, and suicide (Goldenring & Rosen, 2004; NRC/IOM, 2009). Primary healthcare providers may have not received specialized training in providing healthcare to the adolescent population, or may feel uncomfortable engaging in communication about psychosocial risk factors with adolescents (NRC/IOM, 2009). One critical gap involves the fragmented healthcare services available to adolescents and the missed opportunities for health promotion and disease prevention when adolescents do seek healthcare. Incorporating comprehensive psychosocial adolescent histories into practice may help facilitate positive changes in adolescent healthcare delivery. In response to the need for improved adolescent friendly healthcare services, an online continuing education module was created in collaboration with the American Association of Nurse Practitioners Continuing Education Center. The psychosocial assessment focused on utilizing the HEEADSSS assessment, as psychosocial risk factors contribute to the leading causes of adolescent morbidity and mortality (Goldenring & Rosen, 2004; NRC/IOM, 2009). The module was evaluated through pretest, posttest, and evaluation questions. Data were collected for approximately two months, and there were 328 participants. Following completion of the module, over half (52.4%; n = 172) of the participants reported they will modify their practice, and nearly all of the participants (91.8%; n = 301) felt that the level of content was “just right” for nurse practitioners. Five pretest and posttest questions related to the module’s content demonstrated increased knowledge as a result of the module. Additionally, a majority of the written qualitative responses were in support of or praising the quality of the module. Overall, data indicate a positive impact from the continuing education module about conducting comprehensive psychosocial interviews with adolescent patients.
New Referral Hepatitis C Protocol: The New Standard
(North Dakota State University, 2014) Redden, Toby Lynn
The Gastroenterology (GI) clinic at Sanford Health anticipates an increase in patients with hepatitis C virus (HCV) based on the 2012 Centers for Disease Control (CDC) screening recommendations. With a disproportionately high prevalence in the baby-boomer population, 75% of all documented HCV cases, the CDC recommended a “one-time testing of all persons born during 1945-1965 without prior ascertainment of HCV risk” (CDC, 2012a). The purpose of this practice improvement project was to refine the existing workflow of the GI clinic when caring for and managing patients with HCV. The Plan, Do, Study, Act method was followed to improve the processes and address the clinic goals. The project first assessed the existing referral protocol for hepatitis C to improve the quality of care for HCV patients, to increase the clinic’s efficiency, and to identify opportunities for improvement. HCV is a complicated, intense disease process, necessitating chart reviews, patient education, and depression monitoring. To meet these time commitments the department added a new role, the designated hepatitis C nurse. The hepatitis C nurse would serve as a liaison for all HCV patients and providers. The assessment further identified an incomplete process within the referral system. During the pre-appointment chart review for new hepatitis C referrals, many required tests were incomplete. To address the gap with referrals from primary care, a brochure containing a hepatitis C screening algorithm was created. The assessment also identified a need for depression monitoring. To provide safe, up-to-date, treatment monitoring for depression in patients, the Patient Health Questionnaire (PHQ-9) was implemented. The inclusion of PHQ-9 monitoring by the hepatitis C nurse has helped the GI clinic reach its goals for administration compliance. iv Staff members and providers have reported positive impacts at the clinic after the implementation of the new change processes at the GI clinic. Patients have expressed positive satisfaction with the services, particularly the ease of communicating with the GI clinic and consistent personnel since the implementation.

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