Nursing Doctoral Work

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Mental health: implementation of the SMHAT-1 tool to screen for mental health concerns among collegiate athletes attending a midwestern university
(North Dakota State University, 2024) Richter, Chrisann
College athletes experience increased prevalence of anxiety, depression, sleep disorder, substance misuse, and eating disorders when compared to general college student population. When suffering from mental illness, signs and symptoms that elite, or professional athletes portray may mimic behaviors that are normative for dedicated athletes with demanding schedules and high-performance expectations. Early identification by athletic staff, coaches, and healthcare professionals is the key to facilitating early intervention. Routine screening for mental health has been proven effective in identifying athletes who are at risk for, or currently suffering from mental health disorders. Early identification, intervention and treatment offer athletes a better outcome. The purpose of this project is to identify Division I college athletes who may be at risk for, or currently suffering from mental health illness. The mental health of the athletes was assessed over the duration of pre-season to mid-season of the indoor competitive sport season to determine if psychosocial distress is positively correlated with the progression of the sport season. The Sport Mental Health Assessment Tool 1 (SMHAT-1) was administered via Qualtrics survey to freshman, sophomore, junior, and senior track and field athletes at a Midwestern University pre- and mid-season to evaluate the trend in psychological well-being.
Emergency Provider Education for Management of Patients with Suicidal Ideation in Rural Minnesota
(North Dakota State University, 2024) Slivnik, Stephanie
This dissertation investigated the efficacy of an educational intervention aimed at enhancing the management of patients with suicidal ideation in a rural emergency department. Employing a quasi-experimental mixed-method design, the study involved an educational session, administration of online pre-, post-, and post three-month surveys, and an electronic health record review. The data was then compared to determine if provider confidence was impacted by education. The educational session, guided by the ICAR²E mnemonic developed by Wilson et al. (2020), encompassed components focused on identifying suicide risk, effective communication with patients, assessment for life-threatening conditions, risk assessment, strategies to reduce suicide risk, and extending care beyond the emergency department. The target population was emergency department personnel, including aides, nurses, and providers. Surveys were conducted before, after, and three months after the educational session. Electronic health records were reviewed for the three months before and three months after the educational session to review for changes in documentation of referrals and diagnoses. The survey results revealed an increase in confidence in emergency personnel between the pre- and three-month surveys. However, since surveys were not linked, there was no way to identify if the same individuals completed both surveys, so information was not able to confirm increased knowledge or confidence. A chart review was conducted to assess changes in screening for suicidal ideation and depression, as well as changes in referral practices. No changes were noted in either category from the three months before the education to the three months after the education. The co-investigator endeavored to contribute valuable insights into the effectiveness of educational interventions on provider confidence in rural emergency settings while treating patients with suicidal ideation. The outcomes hold implications for healthcare practitioners, administrators, and policymakers involved in refining emergency care protocols, ultimately fostering improved outcomes for patients with suicidal ideation. The comprehensive approach, integrating both qualitative and quantitative methods, helped support a nuanced understanding of the long-term impact of such interventions on clinical practices and provider confidence.
An assessment of barriers to nurse practitioners’ utilizing pharmacogenetic testing for depression
(North Dakota State University, 2024) Entzel, Sierra
As a leading cause of disability worldwide, depression is considered a chronic disease. Medication management is the first-line treatment for moderate to severe major depressive disorder. Medications are selected based on provider experience and preference with a trial-and- error” approach. These medications may take several weeks to reach therapeutic dosing. If it is not tolerated or ineffective for treating the disease, then the medication regimen is changed, requiring a minimum of 4-6 weeks to determine efficacy. This trial-and-error approach to depression treatment can lead to patients living with persistently debilitating depressive symptoms for months, increased healthcare costs due to continued need to seek medical follow-up, or patients discontinuing care due to lack of efficacy early in treatment attempts. In a post-market release study regarding the efficacy of antidepressant use, results indicated that 11% of the United States population takes an antidepressant. Depressed patients that do not benefit from the first antidepressant they are prescribed is 60% (Alemi et al., 2021). Pharmacogenomic testing (PGT) is beneficial in disease management by determining individual genotype responses to specific medications. Incorporating PGT into routine care for depression can lessen the time it takes to reach disease remission as well as avoid any adverse medication effects. Despite the known benefits of PGT, it continues to have a slow adoption rate in clinical practice. Nurse Practitioners (NPs) surveyed aided the co-investigator in assessing current rates of NPs utilizing PGT as well as identifying barriers to use. Understanding limits for using PGT can contribute to developing targeted education in hopes of enhancing the uptake of PGT for managing depression into routine clinical practice. use. Understanding limits for using PGT can contribute to developing targeted education in hopes of enhancing the uptake of PGT for managing depression into routine clinical practice.
Developing a modified diabetes education project in a global health setting
(North Dakota State University, 2024) Harrington, Megan
T2DM (type 2 diabetes mellitus) is a global health challenge, with Latinos, particularly Mexicans, facing a significantly higher risk. Mexico ranks among the top ten countries in terms of T2DM prevalence, with 12.8 million adults living with the condition. In rural Mexican communities, health disparities and challenges associated with social determinants of health often impede effective T2DM management. This highlights the need for targeted interventions and research initiatives. The project aimed to increase participants’ knowledge about T2DM management, assess their perceptions of their diagnosis and management, and distribute evidence-based dietary management information in a resource-constrained setting in Ensenada, Mexico. To assess the participants’ beliefs and perceptions about T2DM, the T2DM Empowerment Scale (DES), a questionnaire consisting of 28 items developed by the University of Michigan T2DM Research Center, was administered. Other studies have utilized the DES and it has been proven to be reliable (Cronbach’s alpha = 0.96) and valid. Post-session, all participants felt very prepared in making healthy carbohydrate food choices. Two-thirds of the participants felt very prepared to identify sugary drinks and foods to avoid. All respondents strongly agreed that they could set meaningful goals. However, two participants identified lack of knowledge and lack of medical care access as significant barriers. Given the enthusiastic participation of the younger population and the trend of younger onset of type 2 T2DM, future projects should consistently offer educational classes within similar communities. The project highlighted the importance of social support and hope in managing T2DM. Therefore, future studies should focus on broadening the target audience and fostering social support networks. The project underscores the critical need for targeted T2DM interventions in Mexico, particularly in resource-constrained settings. These insights should guide future research and interventions, emphasizing the need for educational classes, fostering social support networks, and nurturing hope among similar communities. This approach could significantly improve T2DM management and health outcomes in these high-risk populations.
Assessing Burnout and Resiliency in Doctor of Nursing Practice Students
(North Dakota State University, 2024) Habib, Mary
This project aims to further assess the issue of burnout among Doctor of Nursing Practice (DNP) students, a population that remains understudied in the context of burnout research. DNP students, who concurrently function as registered nurses, graduate students, and novice nurse practitioners (NPs), can face many challenges in their academic journey. The rigorous demands of didactic and clinical coursework have been shown to impact academic success and overall well-being. Existing literature highlights high levels of burnout among DNP students, which affect various aspects of their lives, including personal time, sleep, and relationships. Resilience has been identified as a potential strategy to mitigate burnout, with more resilient individuals experiencing lower rates of burnout and an improved quality of life. By assessing the correlation between these factors, the aim is to shed light on the prevalence and causes of burnout symptoms in DNP students and explore the levels of resiliency within this population. A quantitative descriptive survey was conducted to collect data on burnout and resiliency levels among DNP students. Thirty-one DNP students completed the survey. Burnout scores reflected moderate to high levels in second and third-year students, with first-year students experiencing the lowest rates of burnout. Resiliency scores were below the national average, with third-year students experiencing the lowest levels of resilience. The cynicism component of burnout correlated negatively with resilience, while the professional efficacy component of burnout correlated positively with resilience. There was no correlation observed between the emotional exhaustion component of burnout and resilience. Furthermore, DNP students with resilience exposure experienced lower rates of cynicism and were found to be more resilient than participants who had no resilience exposure. These findings strengthen the theory that utilizing resilience is useful in decreasing burnout severity and increasing resilience. The outcomes of this practice improvement project hold significant implications for the mental health and well-being of DNP students. Interventions can be developed by individuals and educational institutions to potentially prevent and reduce the likelihood of burnout. This project addresses an urgent need for research in this area and underscores the importance of prioritizing the mental health of healthcare professionals in training.
Adolescent obesity pathway: Updating clinical practice guidelines in primary care
(North Dakota State University, 2024) Fechtner, Amanda
Obesity has become a public health crisis with the prevalence of pediatric obesity being one in five children in the United States. The effects of the COVID-19 pandemic and widening social disparities are driving obesity rates up. Preventing obesity in children should be priority but despite our society’s best efforts, children are crossing the BMI threshold and entering an obese BMI range. Advances in medication options are showing promising results for adolescents with obesity when combined with a healthy diet and exercise. Additionally, surgical options are proving to be safe and sustainable options for children 14 years and older. Clinicians who care for adolescents have received minimal education on treatment guidelines for adolescents with severe obesity. This evidence-based practice improvement project sought to find out if providing education on assessment and treatment of obesity in adolescents and providing a sample of clinical practice guidelines to reflect the 2023 American Academy of Pediatrics practice guidelines would adequately provide knowledge to increase clinician confidence in treating adolescents with obesity. The primary goal of this project was to increase the knowledge of clinicians about effective weight loss treatments for adolescents, including bariatric surgery, increase clinician confidence in treating adolescents with obesity, and decrease weight bias barriers. An education session was presented which comprised of education on reducing weight bias perceptions, treating pediatric obesity with lifestyle changes and medications, and when to refer to bariatric surgery. Of the 40 healthcare providers that attended the education, five clinicians filled out the pre- and post-survey. The surveys included six questions asking about confidence in discussing, assessing, and treating obesity in adolescents, the Beliefs About Obese Persons tool, and three questions to assess the quality and effectiveness of the education as a whole. The education was found to increase clinician’s confidence in bringing up the subject of obesity, formulating a treatment plan, and using professional language. More education is needed to adequately educate clinicians on when an adolescent should be referred to the bariatric surgery clinic. Additionally, the education decreased the participants’ belief that an individual is solely responsible for their obesity.
Preconception and Prenatal Care: Assessing and Influencing Knowledge, Attitudes, and Intentions in Women of Childbearing Age
(North Dakota State University, 2024) Stibral, Anna
Maternal and infant morbidity and mortality rates in the United States (U.S.) remain alarmingly high, emphasizing the urgent need for interventions to address healthcare disparities. Access to preconception care (PCC) and early prenatal care is critical for improving health outcomes, yet barriers and lack of knowledge hinder adequate care for many women. This paper presents the findings, discussion, and recommendations from a Practice Improvement Project (PIP) to enhance education and awareness about PCC and prenatal care among women in rural and underserved communities. Flyers were used to recruit women of childbearing age from three rural and underserved communities. The educational module included a pre-intervention survey, a short educational video, and a post-intervention questionnaire. Thirteen participants completed the entire module successfully. Utilizing quantitative methods, the PIP revealed significant improvements in knowledge, attitudes, and intentions regarding PCC and prenatal care following targeted education. Notable increases in knowledge were observed, particularly in crucial areas such as folic acid intake and risks associated with pregnancy. Positive shifts in attitudes and intentions towards seeking care were also noted post-intervention. The project's success was underpinned by applying Dr. Nola Pender's Health Promotion Model and the Iowa Model Revised, guiding design, implementation, and evaluation phases. Recommendations for future projects include recruiting participants in multiple languages and collaborating with clinics to increase participation rates among diverse populations. Dissemination efforts included sharing findings with nurse practitioners through professional networks and publications. Despite limitations such as small sample size and recruitment challenges, the project highlights the importance of educating women on PCC and prenatal care benefits. Healthcare providers can play a crucial role in improving maternal and neonatal health outcomes by addressing barriers and increasing access to comprehensive education. Efforts to promote widespread access to PCC and routine prenatal care are essential for positively impacting maternal and infant health in the U.S.
Improving Caregiver Burden for Professional Caregivers of Dementia Residents
(North Dakota State University, 2024) Anderson, Austin
This practice improvement project examines the burden on professional caregivers of persons with dementia (PWD), aiming to enhance their well-being. With dementia significantly impacting cognitive functions, caregivers face heightened levels of stress, depressive symptoms, and physical health issues, more so than those caring for individuals with other conditions. Utilizing Roy's Adaptation Model (RAM) and the Theory of Caregiver Stress, the dissertation proposes comprehensive strategies to understand and alleviate the challenges faced by caregivers. The core of this practice improvement project aims to enhance the well-being of formal caregivers by implementing a comprehensive training session. This session was designed to equip caregivers with essential knowledge and skills for managing their roles effectively, including stress management techniques, behavior management, communication techniques, and an understanding of caregiver burdens. By addressing the significant challenges faced by caregivers the project highlights the importance of developing support systems and interventions tailored to the needs of both informal and professional caregivers. Objectives of the project include conducting an educational presentation, enhancing caregiver knowledge on dementia care, reducing caregiver burden, and establishing a caregiver support group within the facility. This approach, grounded in theoretical frameworks and focused on practical interventions, sought to alleviate caregiver burden, thereby improving the quality of care for dementia residents and enhancing caregiver well-being. This practice improvement project contributes to the field of dementia care by addressing the critical need for effective interventions and education for professional caregivers, highlighting the project's significance in improving both resident care and caregiver mental health. Data collected included a pre-and post-education knowledge questionnaire, and the PCTB scale scores pre-and one-month post-education. The results indicated there was a perceived positive change in knowledge post-education, and the PCTB scale indicated an improvement in burden over the one-month period. A total of 16 caregivers attended the educational sessions and 14 participated in the data collection surveys. Response rates varied for the knowledge surveys and burden scale post-education when compared to pre-education.
Healthcare Professionals' Education Regarding Human Trafficking Identification and Resources
(North Dakota State University, 2024) Iversen, Madeline
Human trafficking is one of the largest illegal industries with over 40 million adults and children enslaved worldwide. The psychological and physical consequences of human trafficking are high and may impact a victim for their entire life. Approximately 88% of human trafficking victims report receiving medical care during their time captured, and a majority of these victims seek care in the emergency department (ED). Only 11% of healthcare professionals (HCPs) report receiving education on human trafficking. The purpose of this project was to determine if education regarding human trafficking influences HCPs including, nurses, physicians, nurse practitioners (NPs), physician assistants (PAs), registration, education, case management, and technicians comfort level in identifying victims of human trafficking and then providing resources to the victim. This practice improvement project (PIP) consisted of two, one and a half hour educational in-services in-person or by Zoom to a level III healthcare system in the Midwest. Pre- and post-surveys were used to evaluate the effectiveness in improving knowledge and confidence in identifying and providing resources to potential victims. Nine HCPs completed the pre- and post-surveys of the two educational in-services. An overall positive increase in HCP’s perceived knowledge of identification of potential victims and providing resources in this PIP. Two knowledge questions did not show improvement between the pre- and post-survey. Overall, there was a positive increase in HCP’s level of confidence in identifying potential victims and providing local, statewide, and national resources to victims. All participants agreed to finding additional education on human trafficking to be helpful in their job. The co-investigator of this PIP recommends that NPs and other HCPs be educated on human trafficking indicators and risk factors, as well as resources available for victims. The results of this PIP support the increase in perceived level of knowledge and confidence level in identifying and providing resources to victims of human trafficking. NPs and other HCPs can combat human trafficking by identifying potential victims and offering resources.
Improving care of pregnant women through provider education of group prenatal care
(North Dakota State University, 2024) Kautzmann, Morgan
Prenatal care has been associated with improved pregnancy outcomes for both a mother and her unborn child. However, there are still many disparities that exist in healthcare today, resulting in inadequate access to prenatal care for many groups of women. Women face many barriers to prenatal care that can lead to poor maternal and neonatal outcomes such as lack of transportation, scheduling difficulties, inability to pay for services, and other social factors (Abshire et al. 2019; Akamune, 2018; Crocket et al., 2019). Since the early 1900’s, the focus has been on individualized care models, but the benefits of group prenatal care (GPC) have become a pertinent topic of discussion. Both the American College of Obstetrics and Gynecology (ACOG) and the World Health Organization (WHO) have discussed the potential benefits of GPC including improvements in the quality of care, as well as enhanced maternal and neonatal outcomes among diverse populations of women. The focus of this practice improvement project (PIP) was to increase obstetrics providers' knowledge of barriers to prenatal care and educate on the importance of GPC, more specifically the CP® model of care. To better improve prenatal care of women in a central North Dakota OBGYN clinic, obstetrics providers were invited to watch a 25-minute evidence-based PowerPoint presentation with key topics including barriers to prenatal care, ways to reduce barriers to prenatal care, and the benefits of GPC in clinical practice. Providers completed pre- and post-surveys to assess their change in perceived knowledge following the educational module. Four providers responded to the pre-survey and two responded to the post-survey. Results of the project indicated an overall increase in providers’ perceived knowledge regarding barriers to prenatal care, ways to reduce barriers to prenatal care, and benefits of GPC and CP®. In addition, provider intent to implement GPC services into their practice also assessed increased following review of the educational module. Key barriers to implementation of GPC identified by the participants included lack of facility support, staffing, space, and scheduling. The educational module was beneficial in promoting the use of evidence-based research to increase providers’ knowledge of ways to reduce barriers to care through the utilization of GPC.
A practice improvement project improving tobacco and nicotine dependence treatment education in a doctor of nursing practice program
(North Dakota State University, 2024) Bhattarai, Kanchan
Tobacco use is a global epidemic and the leading cause of preventable mortality and morbidity in the United States (Centers for Disease Control and Prevention [CDC], 2022h). Approximately 5.4 million people die annually due to tobacco-related illnesses. About 70% of tobacco users visit primary care clinics annually and even brief advice from clinicians can improve cessation rates ( United States Department of Health and Human Services [USDHHS], 2020). However, four out of nine adult smokers who visited healthcare providers did not receive any advice or counseling on quitting smoking. Lack of training and confidence were identified as a barrier among providers as to why they were not providing regular counseling or pharmacologic intervention (Meijer et al., 2019). This practice improvement project improved the tobacco and nicotine dependence treatment education curriculum in North Dakota State University’s (NDSU) Doctor of Nursing Practice (DNP) program based on the recommendation provided by former DNP student, Dr. Doan (Doan, 2023). Dr. Doan first incorporated tobacco and nicotine dependence treatment education into the DNP curriculum in 2022. This project was implemented in NURS 810 class among DNP students. The education consisted of an online program (NDQuits QuitLogix) and an in-class presentation. Students were provided with toolkits. NDSU DNP students’ knowledge, motivation, confidence in helping people quit tobacco and nicotine, and comfort with providing information about cessation medications, programs and services, and referrals for evidence-based tobacco and nicotine dependence treatment were assessed through pre- and 2-month post-education questionnaires. Motivation to help users quit was high before the intervention began and did not have a significant increase post-intervention. Significant increases in knowledge, confidence, and comfort were observed in helping patients quit and in providing information about cessation medications, programs and services, and referrals for tobacco and nicotine dependence treatment. The results of this practice improvement support the effectiveness of formal tobacco and nicotine dependence treatment curriculum for DNP programs. Additionally, this project serves as a guide for DNP and other primary care programs for adding tobacco and nicotine dependence treatment curriculum into DNP and other primary care professional programs.
Implementation of Interprofessional Education: Respiratory Management in Amyotrophic Lateral Sclerosis
(North Dakota State University, 2024) Campbell, Brooke
Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease that affects nerve cells, leading to muscle weakness, including weakness of respiratory muscles. Respiratory issues significantly contribute to the morbidity and mortality of persons with ALS. Therefore, respiratory management is a critical aspect of care. There is a concerning lack of awareness and knowledge among rural and urban healthcare professionals regarding the respiratory management of persons with ALS. Healthcare professionals need to understand the differences between oxygenation and ventilation and the importance of following evidence-based guidelines. Nurse practitioners play a crucial role in the care of a person with ALS, overseeing and coordinating interprofessional care. Regular care in multidisciplinary ALS clinics is beneficial, but due to the complexity of the disease, persons with ALS often require care from various healthcare professionals in a variety of settings. An interprofessional healthcare approach is favorable for providing the highest quality of care for ALS patients. This project aimed to address the knowledge gap by designing, implementing, and evaluating an educational session focusing on interprofessional collaboration. This project targeted students pursuing healthcare degrees in various disciplines aiming to better equip healthcare students with knowledge before they enter practice. Participants completed pre- and post-surveys to determine if knowledge increased and to elicit attitudes and beliefs about interprofessional education. Quantitative and qualitative methods were utilized. Findings suggest that integrating educational sessions for healthcare students effectively enhances knowledge and positively benefits interprofessional interactions, which can lead to better health outcomes.
Childhood obesity conversations: Motivational interviewing in the brief primary care visit
(North Dakota State University, 2024) Mettler, Nora
Childhood obesity is a global epidemic that sets a child up for future health complications into adulthood. There’s no current consensus on approaching weight-related conversations with patients and families. Nurse practitioners (NPs) are in a unique position to recognize obesity and initiate weight-related conversations with patients and families. Unfortunately, formative educational programs under-educate practitioners in the conduction of obesity conversations, so there is a decreased confidence and resulting avoidance of weight-related conversations. This practice improvement project (PIP) aimed to increase provider confidence and utilize motivational interviewing techniques to initiate and sustain weight-related conversations with children and families with overweight or obesity. The PIP consisted of an hour-long educational video sponsored by the American Academy of Pediatrics (AAP) electronically sent out to new family practice providers in a Nurse Practitioner Fellowship Program (NPFP) and experienced providers in the rural weight-management clinic. Pre- and post-surveys were employed to evaluate perceived confidence and utilization in clinical practice. Surveys also aided in understanding obesity education through formative and continuing education. There were ten eligible participants, six from the NPFP and four from the weight management clinic. The PIP had a total of three participants who were all from the weight-management clinic. There were no participants from the NPFP. Through descriptive statistics, the co-investigator found that 2/3 of respondents had increased levels of perceived confidence regarding weight-related conversations with children and families with overweight or obesity. One participant indicated weight-related conversational training in formative schooling and all respondents reported weight-related conversational training through continuing education. One participant completed the one-month follow-up survey. The participant indicated he/she had implemented techniques presented in the video, but a larger population size is needed to make the results more meaningful. Although the results supported the purpose of the PIP, the co-investigator would recommend further research targeting primary care practitioners to determine the need for further education in the primary care setting. Although limitations existed, the education and delivery method met the needs of the participants. The co-investigator recommends implementing weight-related conversation education into primary care formative education and encourages practicing practitioners to seek out continuing education regarding weight-related conversations with patients and families.
Pediatric Preparedness in a Rural Health System
(North Dakota State University, 2024) Nielsen, Sarah
Pediatric emergencies present significant challenges and emotional strain in healthcare settings. In critical access hospitals, the provision of safe, effective, and high-quality emergency response for pediatric cases is especially demanding. Many rural hospitals have infrequent exposure to pediatric emergency care, which can contribute to a lack of confidence when caring for this population. Diminished confidence in pediatric skills and procedures has been linked with a reduction in overall patient safety. Research on pediatric emergency preparedness in rural settings outlines the need for further multi-faceted education to achieve increased provider comfort and preparedness. The practice improvement project aimed to understand health provider comfort related to pediatric trauma preparedness at a critical access hospital in rural southwest North Dakota. A pediatric education-based seminar was developed in response to the facility healthcare providers’ educational needs and was implemented to further evaluate the impact that simulation, didactic education, and hands-on skills have on perceived comfort and knowledge. Evaluation of the concluded practice improvement project showed valuable insights into the state of pediatric preparedness in rural healthcare. A pre-seminar needs assessment and post-survey were administered. Post-survey results reflected an increase in knowledge related to caring for pediatric patients after the seminar. The positive influence of education reflected an increase in comfort levels among participants. Many participants felt that their future practice would be changed due to the seminar education. Findings supported a need among healthcare providers for regular education and training. Overall, the analysis and results of the project supported the need for future pediatric preparedness training and the positive impact that education can have on healthcare providers. These findings support the project's potential to influence the future direction and emphasis of rural health education.
Colorectal Cancer Education: Utilization of an Inflatable Colon and Small Media at a Health Fair in Central North Dakota
(North Dakota State University, 2024) Himmelspach, Faune
Colorectal cancer is a prevalent and deadly disease, claiming thousands of lives each year. In the United States alone, over 150,000 individuals were diagnosed with colorectal cancer in 2022, and tragically, nearly 53,000 succumbed to its impact (National Cancer Institute [NCI], 2022). Notably, North Dakota faces a unique scenario, with incidence rates per capita surpassing the national average, yet colorectal cancer screening rates lag behind. This disconcerting situation in North Dakota emphasizes a need for targeted public health interventions, increased awareness campaigns, and improved access to colorectal cancer screening services. Early detection through screening is a pivotal tool in the battle against colorectal cancer, often identifying the disease in its precancerous or early stages, thereby significantly reducing mortality rates. Technologies are available and offer non-invasive, painless, cost-effective, and practical manners that can sometimes be tailored to the individual's preferences. Despite these advancements, the United States and North Dakota fall short of the 80% CRC screening benchmark established by the National Colorectal Cancer Roundtable. Shockingly, in 2020, only 63% of eligible North Dakotans underwent colorectal cancer screening, which is 10% below the national average and well below the national benchmark. High incidence rates, mortality rates, and increasing incidence of early-onset CRC indicate a need for immediate action. Efforts to bridge the gap between increasing incidence rates and low screening rates are essential to save lives and reduce the burden of colorectal cancer in North Dakota. This evidence-based scholarly project aimed to assess the impact of an educational intervention on colorectal cancer awareness and screening intent. The intervention involved scripted guided tours of a larger-than-life inflatable colon, a PowerPoint presentation set on loop, and educational handouts all strategically deployed during a health fair sponsored by the Missouri Valley YMCA in Bismarck, ND. Participants, ranging from 18 to 75 years old, engaged with the educational initiative, with the primary goal of enhancing their knowledge of colorectal cancer and influencing their intent to undergo screening. Additionally, the co-investigator sought to uncover and address perceived barriers to colorectal cancer screening within this specific demographic.
Initiation of an adolescent school-based electronic nicotine delivery system prevention program
(North Dakota State University, 2024) Schneider, Morgan
The leading cause of preventable disease, disability, and death in the United States is tobacco product use. The 2022 National Youth Tobacco Survey, which was completed in 2022, showed that the e-cigarette epidemic among youth continues to remain a public health threat. The survey revealed that over 2.5 million middle and high school students currently use e-cigarettes. The purpose of this project was to provide youth with evidence-based education in a classroom setting. The education was designed to increase participant knowledge about health-related concerns of ENDS products, decrease participant intent to use ENDS products, and foster sustainability through training a school staff member in CATCH My Breath (CATCH, 2022). Seventh grade students at Kindred Middle School were educated using the CATCH My Breath (CATCH, 2022) vaping prevention program. The education was taught by the co-investigator and occurred in one class period for four weeks. This project was evaluated using pre- and post-survey results from the students. The need for e-cigarette prevention in youth is evident. While the knowledge questions from this project did not show a statistically significant change, students demonstrated through comments, class discussion, and activity completion that they found the experience to be beneficial and educational. Enhanced knowledge is expected to decrease students’ intent to use ENDS products in the future. Lastly, staff member CATCH My Breath (CATCH, 2022) training was accomplished on the last day of implementation. E-cigarette prevention is recommended due to continued rise in youth’s e-cigarette use and the significant harm associated with it.
Associations between human papillomavirus vaccine hesitancy and resistance and social media engagement
(North Dakota State University, 2024) O'Keefe, Katherine
Human Papillomavirus (HPV) is one of the most common sexually transmitted infections worldwide. More than 13 million Americans are infected each year. Typically, HPV infections will resolve without treatment, and many infected individuals are asymptomatic. However, in some cases, these infections can lead to penile, oral, vaginal, cervical, and/or anal cancer. With the rise in HPV infection rates, the need for vaccination is crucial in prevention of HPV-related infections and cancers. The CDC recently changed HPV vaccine guidelines to include individuals ages 27-45. Regardless of guideline changes, HPV vaccination rates are lower than other recommended vaccines, which may be due to antivaccination campaigns. The purpose of the practice improvement project was to identify attitudes, beliefs, and barriers towards HPV vaccination and sources of vaccine information among residents, ages 18-45, in a rural North Dakota county. The project was conducted between May 2023 and June 2023. Participants completed an online survey via Qualtrics to assess views, social media usage, influences, and any potential barriers to HPV vaccination. Each participant who completed the survey were provided links to websites for further information on HPV and the vaccine. Over 30% (n=9) of the 28 participants utilized search engines for their health and vaccine information, while 29% (n=8) utilized their primary care provider. Approximately 5% (n=2) of the participants utilized social media sites for their health and vaccine information. A majority (n = 18; 64.3%) of participants report they would receive the HPV vaccine if recommended by a provider. Rural providers were educated on survey results and determined that changes within their practice were needed to increase HPV vaccination rates. Providers identified the importance of increasing HPV vaccine uptake to help better serve their community. These providers planned to display an HPV infograph within their clinic and continue to offer the HPV vaccine at annual wellness visits. Continued HPV vaccine education provided by healthcare professionals is imperative to enhance HPV vaccine confidence and uptake, which has the potential to reduce morbidity and mortality associated with HPV and HPV-related cancers.
Advance care planning: implementing online education for rural primary care providers
(North Dakota State University, 2024) Kurtz, Jessica
Advance care planning (ACP) can assist patients and their families in navigating personal and medical choices at the end-of-life; however, these conversations often transpire too late. Primary care providers (PCPs) frequently develop extended relationships with their patients, especially those with chronic disease, and possess opportunities throughout a patient’s lifespan to assess when ACP conversations could be initiated. Unfortunately, many PCPs lack confidence in leading ACP conversations, although they are willing to facilitate them. Despite the alarming number of people living with chronic disease and documented benefits of ACP, advance directive completion remains low. According to previous research, online ACP education for PCPs can bridge gaps in end-of-life care by increasing overall perceived knowledge, confidence, and understanding of ACP and advance directives. The purpose of the practice improvement project was to improve rural PCPs perceived knowledge and confidence in facilitating ACP discussions and to increase the completion rate of advance directives among adults living with chronic disease(s) seen within the rural primary care setting. The theoretical underpinning for this DNP project was Lewin’s Theory of Behavior Change. Project implementation occurred within a federally qualified health center comprised of eight clinics throughout rural North Dakota. The project’s design methodology was a quantitative, quasi-experimental study using a convenience sample of eight PCPs employed within the federally qualified health center. Participants could access the ACP educational webinar, surveys, and posttest for four weeks. Four participants (50%) participated in the practice improvement project and acquired continuing education credit from the North Dakota Board of Nursing. The surveys aided in assessing participants’ reported ACP knowledge, confidence, perceived benefits of ACP, and prior experiences in initiating advance directives and ACP conversations before and after viewing the webinar. The outcomes of the practice improvement project objectives were evaluated and demonstrated an increase in participants’ perceived knowledge and confidence of ACP, an increase in PCPs' reported knowledge of the Serious Illness Conversation Guide, and an improved understanding of the role of ACP facilitators.
Dermoscopy education to improve provider confidence in skin cancer identification
(North Dakota State University, 2024) Ova, Hayli
Skin cancer is the most common form of cancer in the United States and is becoming more prevalent each year. Patients often consult their primary care provider (PCP) for initial evaluation of skin lesions, and PCPs typically use naked-eye examination (NEE) to evaluate the lesion. Using NEE alone can yield varying results of accuracy and differential diagnosis. PCPs can utilize a dermatoscope to aid their visual inspection of suspicious lesions. Dermoscopy, a non-invasive technique for examining skin lesions, has been recognized as an invaluable tool in the early detection of skin cancer. While traditionally used by dermatologists, the need for early identification of skin cancer demands that PCPs utilize dermoscopy to improve patient outcomes. This practice improvement project aimed to increase PCPs accuracy in dermoscopic analysis while improving confidence in performing skin cancer screening and dermatoscope use. The practice improvement project utilized a pre-training assessment and dermoscopy training that was presented in-person at a primary care clinic in the Midwest and was available online to providers unable to attend in-person. The training was created to equip providers with knowledge of dermoscopy principles, the PASS algorithm, and the ability to differentiate between benign and malignant lesions. Following the training, the clinic was provided with two dermatoscopes, as well as a binder containing PASS algorithm and training references. Providers then had three months to utilize dermoscopy in their clinical practice prior to taking the post-implementation assessment. Pre- and post-assessments were used to gauge the participants' knowledge and confidence levels throughout the project. Project results support literature findings, including actual and perceived improvement in knowledge and confidence of skin lesion identification and triaging. Continued rise in skin cancer prevalence necessitates PCPs to become more proficient in secondary prevention strategies. The project concluded with the need to advocate for the integration of dermatoscope access and training aimed to equip PCPs with the necessary skills to effectively identify and prioritize skin lesions. By empowering PCPs with the skills to use dermatoscopes in combination with the PASS algorithm, communities can benefit from early detection of skin cancer, fewer unnecessary referrals, and better healthcare outcomes.
Childhood Obesity Prevention: Infant Nutrition and Feeding Education
(North Dakota State University, 2022) Mecklenburg, Candace
Childhood obesity is a global concern, as of 2020 it affected 39 million children under the age of five. Obesity increases the risk of developing many health problems, including type-2 diabetes, hypertension, heart disease, asthma, sleep apnea, and others. Overweight and obese children are more likely to become obese adolescents and adults. Once obesity occurs, it is likely to persist as achieving and maintaining a healthy weight is more challenging. Many of the diseases related to obesity are now developing in children and adolescence. Preventing obesity from occurring has the most promising effect on tackling the issue. Researchers have found that food preferences and eating patterns are developed in the first two years of life, therefore, in order to prevent obesity from occurring, focus should be placed on nutrition during infancy. This practice improvement project aspired to increase parental knowledge regarding healthy nutrition and feeding during infancy. An educational session was conducted during a childbirth preparation class. A post education survey showed that participants did report an increase in their knowledge regarding healthy nutrition and feeding during infancy.

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