Nursing

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Research from the School of Nursing. The website may be found at https://www.ndsu.edu/nursing/

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The Relationship between Epidural Analgesia during Childbirth and Childbirth Outcomes
(North Dakota State University, 2004) Ramstad, Marsha
Epidural analgesia has increased in usage dramatically in the United States as a means of comfort for labor pain. Prior studies have connected epidural analgesia to an increase in cesarean birth rate, an increase in use of instrumentation, an increase in length of labor, episiotomy rate, and maternal fever. Epidural analgesia has produced additional costs to the patient and society. The purpose of this study is to examine the relationship between epidural analgesia during childbirth and childbirth outcomes. The data for this study were obtained from a retrospective patient record review of 200 systematically selected labor patients who delivered in 2002 at a midwestern hospital. The epidural analgesia rate was 72% at this facility in 2002, a signiﬁcant increase from the previous 5 years. Using the Chi-square test of independence, 3 relationship was established between epidural analgesia and four of the variables examined. A statistically signiﬁcant relationship was found to exist between epidural analgesia and cesarean birth rate, pitocin augmentation, and the ﬁrst and second stages of labor with the total sample. The results of the study are important for healthcare providers who are relaying inﬂuential wellness information to childbearing women and their partners. The results indicate a need for further education for healthcare providers on alternative methods of pain relief for their patients during childbirth.
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.
End-of-Life Issues for Native American and Alaska Natives: A Critical Literature Review
(North Dakota State University, 2013) Terpestra, Jodi Lynn
This paper conducts a critical literature review on end of life issues relating to Native Americans and Alaska Natives. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was used to guide this literature review. In particular, a PRISMA flow diagram which outlines the various steps of the critical literature review is given. The review identified 18 papers. Although all of these papers fit the inclusion criteria, there was very little uniformity among them. Six common themes emerged; namely, communications, program development, spirituality, rituals, advance planning, and guidelines. A detailed discussion of these six themes along with nursing implications is presented. While work is being done to develop cultural competence, it is apparent nurses must continue to develop their skills related to these six areas of concentration in order to improve end of life car in Native American and Alaska Native populations.
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.
The Impact of Simulation Experiences on Nursing Student’s Satisfaction and Self-Confidence in Learning
(North Dakota State University, 2013) Graening, Shelly
Previous research has shown that high fidelity simulation experiences impact the satisfaction and self-confidence of nursing students. The purpose of the study was to examine the student satisfaction and self-confidence in learning of students in the pre-licensure baccalaureate nursing track and the associate to Bachelor of Science in Nursing (BSN) track at North Dakota State University. The data was obtained from two different courses in two different semesters of study. The surveys used in the descriptive, comparative study included a tool to collect demographic data and the Student Satisfaction and Self-Confidence in Learning Tool. The data revealed that nursing students were satisfied and self-confident in their learning during simulation experiences. The results will assist nurse educators to recognize the importance of providing nursing students opportunities to care for complex, high-risk patients in a low-stakes setting. Nurse educators can then assist in bridging the gap between classroom and clinical practice.
Development of the Jagim Lean Real Time Location Systems Model for Healthcare
(North Dakota State University, 2013) Jagim, Mary Kelly
The critical challenge for healthcare today is to be a high quality/low cost provider. However, healthcare is struggling to meet the challenge in terms of quality, outcomes and cost. Healthcare is in need of a blueprint for transformation, leveraging new knowledge and innovation, while consistently and reliably delivering quality and controlling cost. Integrating the process change methodology of Lean with the enterprise visibility afforded by RTLS offers a wealth of exciting options for transformation, yet there is no existing model or defined body of research regarding the application of RTLS within a Lean methodology. The purpose of this project was to design a new model to be known as the Jagim Lean RTLS Model for Healthcare, that integrates the methodology of Lean with the capabilities of RTLS with nursing as a central figure in the healthcare delivery transformation process.
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.
Perception of Nursing Empowerment and Intent to Stay
(North Dakota State University, 2013) Schmaltz, Joyce Marie
Nursing turnover and the evolving nursing shortage has continued to receive much attention from health care organizations. It is predicted that there will be 1.2 million job openings in nursing by 2020. Work empowerment has been associated with organizational commitment and intent to stay in current job. The purpose of this study was to evaluate if there is a relationship between the perception of organizational structural empowerment and intent to stay. The theoretical framework utilized was Kanter's Structural Theory of Organizational Empowerment. The population for the study included 1,159 nurses in a large, nonprofit, Midwest medical center. Data was collected through an online survey with a response rate of 22.7%. The overall results demonstrated perceived moderate levels of structural empowerment. Higher structural empowerment scores were noted in the respondents indicating intent to stay. The research demonstrated a positive correlation between empowerment scores and intent to stay.
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.
Comparison of Burnout and Empowerment Between New Graduate and Experienced Nurses Employed in Acute Care
(North Dakota State University, 2014) Schaeffer, Kolby Lee
The nursing profession is expected to experience massive staff shortages due to experienced nurses reaching retirement and new nurses leaving the profession related to feelings of burnout. This study describes quantitative and qualitative perceptions of new graduate and experienced nurses employed in acute care. Two measurement tools, the Maslach Burnout Inventory (MBI) and the Conditions for Work Effectiveness Questionnaire (CWEQ-II), were administered using an online survey. An overall moderate level of burnout and empowerment were identified. Unit clusters differed in both burnout and empowerment subscale responses. New graduates differed in some responses regarding burnout, specifically depersonalization. Additionally, two open-ended questions provided insight about the participants' opinions regarding burnout and empowerment. Four burnout themes were identified: challenging work milieu, need for better compensation, desire for increased managerial support, and toll of professional demands. Four empowerment themes were also identified: feeling valued, positive communication, nurse retention, and wholesome relationships.
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.
Stress Levels of Nurses in Oncology Outpatient Units
(North Dakota State University, 2014) Ko, Woonhwa
The purpose of the research was to identify stress levels of outpatient oncology nurses, to investigate stressful factors of nurses at the workplace, to identify differences in stress levels among nurses’ demographic characteristics, and to explore coping behaviors for occupational stress of nurses. Study participants (n=40) included registered nurses and licensed practical nurses who completed the Nursing Stress Scale, three open-ended questions, and demographic questionnaire. Three different levels of stress were identified: 45% (n=18) were considered as ‘no stress or less stressed,’ 52.5% (n=21) were regarded as ‘moderately stressed,’ 2.5% (n=1) were considered as ‘highly stressed.’ The highest sources of stress were the factors of work load and patient death and dying. There were significant differences in stress levels among the demographic characteristics of age (p-value=0.0411) and nursing work experience (p-value=0.0412). The three most frequently used coping behaviors were verbalizing, exercising/relaxing, and taking time for self.
Maternal Breastfeeding Satisfaction: Attendance or Non-Attendance at a Nurse-Led Breastfeeding Support Group
(North Dakota State University, 2014) Christoffers, Collette
The benefits of breastfeeding for mothers and infants are well documented in the literature. This study compared maternal breastfeeding satisfaction between mothers who attended a nurse-led breastfeeding support group (n=27) and mothers who did not attend the group (n=26). No statistical difference in maternal satisfaction was identified between the groups of mothers. While the sample size was small, qualitative data collection indicated mothers who attended the group may not have had as high of breastfeeding satisfaction scores if the support group was not available for them to attend. Breastfeeding mothers indicated their husband/significant other was their primary source of support (36 surveys or 68%) and lactation nurses (32 surveys or 60%) were their primary source of education. Individualized support based on a mother’s personal circumstances is ideal. More research is needed to identify the best ways to support mothers who are breastfeeding and what is most helpful from their perspective.
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.

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