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Item Skin Cancer Screening in Primary Care Using Dermoscopy(North Dakota State University, 2020) Lubitz, Erin ElizaSkin cancer rates continue to rise affecting millions of individuals annually. While cutaneous malignant melanoma comprises a fraction of total skin cancers diagnosed, melanoma is associated with a poor prognosis and higher mortality rate when compared to other forms of skin cancer. The greatest risk factor for skin cancer is the amount of ultraviolet light exposure making skin cancer the most common preventable form of cancer. In conjunction with primary prevention, part of secondary prevention measures involves performing routine skin examinations. According to data from the National Health Interview Survey, only 8% of individuals who had seen a primary care provider in the previous 12 months had a skin examination performed (Johnson et al., 2017). A low rate of skin examination can largely be attributed to current professional guidelines from the United States Preventative Services Task Force (2016) not supporting routine skin screening of all patients. Despite the recommendation, primary care providers are consistently faced with the need to evaluate skin lesions. Other barriers identified include lack of training and practical screening methods. Dermoscopy is a noninvasive technique for identifying skin lesions. Based on the need for improved screening practices and identified barriers, a brief educational session and resource on skin cancer and dermoscopy was presented to primary care providers at an urban family practice clinic in eastern North Dakota. Following the educational session, a three-month implementation period provided time for providers to implement their knowledge and dermoscopy skills in practice. The purpose of the project was to increase knowledge, improve accuracy of identifying skin lesions, and increase provider confidence using dermoscopy. Evaluation using a pre-implementation survey of providers in the clinic found the primary care providers felt comfortable with their baseline knowledge of skin cancer but did not feel confident in their ability to use a dermoscope. Most of the participating providers deemed their level of knowledge regarding dermoscopy to be at a novice level. Results of the post-implementation found providers felt more comfortable using dermoscopy and knowledge in dermoscopy overall improved from novice to advanced beginner or competent.Item Addressing Student Depression on Campus: Barriers and Assets(North Dakota State University, 2015) KappelmanBeyer, DiannePrevalence of depression among college students is noted to be approximately 30% per college and university campus with an overall national average for severe psychological problems, including depression, at approximately 86% (Field, Diego, Pelaez, Deeds, & Delgado, (2012). Outcomes of undiagnosed depression lead to heightened levels of stress and dangerous behavior patterns, such as drug and alcohol consumption, poor academic achievement, high rates of college dropout, chronic and progressive mental illness, and suicide (Deckro et al., 2010). Depression prevention is important for college student health because of the chronic, recurrent and progressive nature of the disease along with student academic success, college retention, and overall quality of life (Buchanan, 2013). Purpose of this practice improvement project was to impact student health at North Dakota State University (NDSU). The project was accomplished by investigating students' depression-prevention practices, current practices for universities, and evidence-based practice. Several NDSU departments participated in the interviewing of staff members' investigation process for information gathering. Depression prevention is imperative for emerging adults within the college and university system. Providing depression prevention strategies would not only benefit the student, but also the university with improved student retention. Recommendations for depression prevention are to employ a nurse practitioner specialized in mental-health, as this would fulfill the overall student mental-health care needs by utilizing a depression prevention model such as the Peden cognitive behavioral group intervention, depression education for students either individualized or classroom by adding a chapter regarding depression to University Studies 189, and provide mental-health care services. Strategies for college and university student depression prevention practices were investigated at public university websites and published articles. Existing research was available through library access. Through this investigative research process, the Peden Cognitive Behavioral Group Intervention (CBGI) was determined to be a valid, evidence-based depression prevention model for college students. Results and recommendations from this practice-improvement project were presented to NDSU stakeholders to advocate for a student depression model among university students. This practice improvement project examines the importance of being proactive with depression prevention along with evidence-based recommendations leading to healthier student populations, more student safety, and improved student retention.Item Advance Care Planning and Advance Directives: Implementing Online Education for Healthcare Providers(North Dakota State University, 2022) Murphy, HannahAdvance directives (ADs) summarize goals or preferences for future care regarding life-sustaining treatment and designates a surrogate decision-maker in the event a patient is unable to make healthcare decisions. These legal documents are especially important for providing patient autonomy and allowing people to communicate their medical care preferences to family, friends, and healthcare professionals. Two thirds of Americans have not completed an advance directive and 70% of Americans (more than 1.7 million) die of chronic diseases. Benefits of ADs include: autonomy during end-of-life, honored preferences, enhanced quality of medical decisions, less emotional distress, and even a decrease in healthcare costs. Approximately 60% of patients stated that they are open to talk about advance care planning (ACP); however, only 21% percent of providers reported talking frequently about matters related to ACP or end-of-life care. Literature review findings revealed that providers lack training and education about ADs and ACP conversations, leading to discomfort in skills, confidence, and knowledge about having these essential discussions. The purpose of this practice improvement project (PIP) was to increase nurse practitioners’ knowledge of facilitating ACP conversations, and completion of AD among patients living with a chronic disease, over the age of 65, seen within the primary care setting. A total of 14 healthcare professionals participated in a one-hour educational webinar posted on the North Dakota Nurse Practitioner Association (NDNPA) website over a three-month time period between September 30, 2021 and December 30, 2021. Pre/post Likert scale surveys were administered to each participant electronically via Qualtrics. Confidence Likert scale surveys found the education increased participants’ knowledge, confidence, and understanding of ACP and AD. PIP findings also demonstrated an increase in understanding of the Serious Illness Conversation Guide and an increase in both confidence and likeliness of increasing and initiating ACP conversations with patients. Education on ACP and AD resources should continue to be provided for healthcare providers online. Future research should look into how providing ACP and AD education directly affects AD rates in patients living with a chronic disease, over the age of 65, seen within the primary care setting.Item Implementation of Fluoride Varnish as a Quality Improvement Intervention for Primary Care Providers in a Rural Pediatric Population(North Dakota State University, 2015) Dimler, Laura A.The purpose of this study was to study implementation of preventive oral health interventions by primary care providers in a rural pediatric population. Acknowledgement of dental caries as a preventable communicable disease indicates that activities and interventions to prevent oral complications are being expanded to multiple disciplines. Primary care providers are acknowledged as partners in health and prevention of chronic illness. Practices including oral risk assessment and fluoride varnish are proposed interventions recommended by dental care providers to be included in primary care in rural or high risk populations not receiving dental services. Collaboration between dental services and pediatric primary care in the communities of central and northwestern North Dakota is proposed as a method to bridge the gap of health disparities between urban and rural counterparts. The study included five rural clinics and involved 25 providers in education regarding fluoride varnish application and oral risk assessment. Rating of oral health knowledge before the intervention and after the intervention on a 1 to 10 scale by primary care providers was 6.05 (n=23) and 6.33 (n=18) respectively. Following education and introduction of fluoride varnish into practice, 16.7% (n=18) primary care providers indicated using fluoride varnish. Nurses were the majority of respondents in the study and the most likely to perform fluoride varnish. Implications from the study indicate further incentives will be necessary to increase the number of primary care patients treated with fluoride varnish. The North Dakota Oral Health program reports 4,609 Medicaid claims were filed for oral prevention services by primary care providers in 2012-2014, the period during which concerted efforts to educate providers and implement fluoride varnish were initiated.Item Adult ADHD Self-Report Scale: Implementation in a Primary Care Setting(North Dakota State University, 2015) Treumer, Taryn NicoleAttention Deficit Hyperactivity Disorder (ADHD) is a chronic, highly prevalent, neurodevelopment disorder in children, which often persists into adulthood. A gap exists among healthcare providers' knowledge of adult ADHD and current screening practices in the primary care setting. The purpose of the project was to improve screening and identification of adult ADHD in the primary care setting by enhancing provider knowledge and awareness of the disorder. A need was identified at a small, rural, facility in Midwestern, North Dakota to improve adult ADHD screening practices; thus the adult ADHD Self-Report Scale version 1.1 (ASRSv1.1) was implemented among a group of providers for a five month time period. The ASRSv1.1 is a six question rating scale which was created by a group of ADHD experts and copyrighted by the World Health Organization. The sensitivity of the tool is 68.7 percent while the specificity rate is a remarkable 99.5 percent. For the practice improvement project, providers were instructed to screen patients displaying signs and/or symptoms of inattention, hyperactivity, impulsivity, depression, anxiety, substance abuse, etc. If the screen was found to be a positive, recommendations were to refer the patient to a mental healthcare professional. The results of the project demonstrated an overall improvement in the screening process for adult ADHD. An increase of patients referred for further diagnostic testing of adult ADHD was found. Providers felt the ASRS v1.1 was a helpful in screening and determining the course of care for the patient. Recommendations from the practice improvement project for future research include replicating the study with a larger sample size; providing easy access to the ASRS v1.1; and screening patients identified as routinely missing appointments for ADHD.Item Addressing Lyme Disease: An Educational Module for Healthcare Providers(North Dakota State University, 2017) Greseth, SheilaSince its identification over 40 years ago, Lyme disease has continually spread, and the number of cases have significantly increased in the northeastern and northcentral United States. The Center for Disease Control and prevention (CDC) estimates that approximately 30,000 individuals in the United States per year are diagnosed with Lyme disease (2016). Lyme disease is a vector-borne disease that is caused by Borrelia burgdorferi, a bacteria transmitted by the Ixodes scapularis tick. The disease presents in numerous ways, often making the diagnosis difficult. Healthcare providers have the opportunity to reduce and prevent health complications associated with Lyme disease, but substantial knowledge gaps are present in relation to the overall care of patients with the disease (Hill, 2013). In addition, numerous healthcare providers within the United States have reported not feeling confident in their knowledge level of tick-borne disease (Brett et al., 2014). By facilitating healthcare providers learning through a continuing education module, they may improve their practices and provide more competent, safe, and high quality care for patients with Lyme disease. With the apparent need for increased knowledge and awareness of Lyme disease among healthcare providers, a continuing education module was constructed for distribution with the American Association of Nurse Practitioners Continuing Education Center. Information on the prevention, diagnosis, and treatment of Lyme disease was incorporated into the module to educate healthcare providers. The online module evaluated Lyme disease knowledge through a pretest, posttest, and evaluation survey. Approximately 10 weeks of data were collected with a total of 305 healthcare provider participants. As a result of the continuing education module, learning was demonstrated by improvement on 17 of 18 pretest and posttest content-related questions. Additionally, approximately 93% (n = 283) of participants felt the continuing education module enhanced their current knowledge base. In summary, results demonstrated that the continuing education module impacted the participants positively by advancing their knowledge of Lyme disease prevention, diagnosis, and treatment.Item Improving Resident Assistants Knowledge about Eating Disorders on a College Campus(North Dakota State University, 2016) Bergseth, RaynaAs many as 30 million people in the United States have struggled with an eating disorder (National Eating Disorder Association [NEDA], n.d.). Anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are the most common types of eating disorders. Approximately 20% of college students report that they have had disordered eating at some point in their lives (Tillman, Arbaugh, & Balaban, 2012). Prevalence of eating disorders among college students is estimated to be between 8 and 17 % (Eisenberg et al., 2011). According to NEDA (2013), there is an unmet need for the identification and referral of students with eating disorders. The project’s aim was to increase the knowledge of and awareness about eating disorders on the college campus by educating resident assistants (RAs). RAs have daily interactions with students and contribute to the campus’ positive living and learning environment. To accomplish the goal, information about eating disorders was presented to the RAs at a monthly meeting. Through a PowerPoint presentation, RAs were informed about the most common eating disorders, how to recognize the signs and symptoms for the most common eating disorders, available eating disorder resources, and how to approach an individual with disordered eating behaviors. The attendees were asked to complete two evaluation forms following the presentation, initially and four weeks post presentation. The evaluation tools contained Likert-scale statements and open-ended questions. The initial evaluation was completed by 115 participants, and the follow-up evaluation was completed by 10 participants. Because the follow-up evaluation was only completed by 10 participants, the results of the second evaluation could not be compared to the initial evaluation. A majority of participants responded positively (agree or strongly agree) to the eating disorder presentation. The follow-up evaluation revealed that two individuals with disordered eating behaviors were recognized and referred for further evaluation. One recommendation for future research includes extending eating disorder training to other members on the college campus.Item Development of Prenatal Educational Library in the Somali Language for Family Healthcare(North Dakota State University, 2014) Garrett, Karon JoyceThe 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.Item A practice improvement project improving tobacco and nicotine dependence treatment education in a doctor of nursing practice program(North Dakota State University, 2024) Bhattarai, KanchanTobacco 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.Item Combating Youth Depression in Primary Care(North Dakota State University, 2016) Chesley, Kayla LynnYouth depression is a serious mental health disorder that may have detrimental consequences. Half of all lifetime cases of mental illness begin before the age of 14 (Hagan, Shaw, & Duncan, 2008). Depression in youth is linked to increased morbidity and mortality, along with high-risk behaviors. Mental health and mood disorders are the leading cause of illness and burden among youth (Patel, 2013). Nationally, suicide is the third leading cause of death for individuals aged 15 to 24. In North Dakota, suicide is the first leading cause of death for individuals aged 15 to 24 (American Foundation for Suicide Prevention, 2016). Unfortunately, depression remains largely underdiagnosed and undertreated; only about 50 percent of youth with depression are diagnosed before they reach adulthood (Zuckerbrot, Cheung, Jensen, Stein, & Laraque, 2007). The purpose of this project was to improve the mental health of youth through increasing universal screening in the primary care setting, and improve the confidence and ability of the primary care provider to diagnose and treat youth depression. Primary care provider education was launched through collaboration with Essentia Health, providing education regarding youth depression focused on universal screening, identification of youth depression, and treatment modalities. To evaluate primary care provider education, a pretest/posttest was completed, along with key stakeholder interviews. Surveys demonstrated an increased intent to screen and increased confidence in identifying and managing youth depression. The interview with key stakeholders was used to determine the effectiveness and feasibility of universal screening and management of youth depression in the primary care setting.