Text

Chronic kidney disease (CKD) affects millions globally, often remaining undiagnosed until reaching advanced stages. Early detection, especially in high-risk populations such as those with diabetes, hypertension, or a family history of CKD, is critical for improving outcomes (National Kidney Foundation, 2020). Diabetes is the leading cause of CKD, followed by hypertension, and screening for microalbuminuria is an effective, low-cost method for early detection. This Doctor of Nursing Practice (DNP) project sought to improve healthcare providers' knowledge, attitude, and practices (KAP) regarding CKD screening and management by implementing newly released Kidney Disease: Improving Global Outcomes (KDIGO, 2024) clinical practice guidelines in the primary care setting. The project was conducted at the HANDS Clinic where eight providers who had direct patient care participated. It utilized educational tools, including an audio-video presentation, a mobile app, and infographic posters, to support protocol adoption and promote evidence-based screening. Providers completed pre- and post-intervention questionnaires during a six-week period to assess changes in KAP. Results showed significant improvements in providers' understanding of CKD risk factors and screening criteria and increased confidence in managing at-risk patients. These findings suggest that structured screening protocols, supported by educational resources, can positively impact provider-driven preventive care, leading to earlier CKD detection and improved patient outcomes. This project serves as a model for primary and community health clinics to enhance health promotion and disease prevention for individuals at risk of CKD (Bello et al., 2019). The project supported Healthy People 2030 goals by increasing diabetic kidney screening, raising awareness of CKD, and reducing disease burden. It also aligned with Triple Aim initiatives by improving care quality, reducing costs, and promoting better health outcomes in the diabetic population.

This project aimed to address the challenge of managing non-motor symptoms in individuals with Parkinson’s disease (PD) through a mindfulness-based intervention. Non-motor symptoms, including mood disturbances, cognitive impairments, and urinary issues, significantly impact the quality of life and are often overlooked in clinical practice. The mindfulness program demonstrated statistically significant reductions in UPDRS Part I scores post-intervention (t(4) = 5.31, p < .01), highlighting improvements in emotional and cognitive symptoms. NMSS data revealed Mood/Cognition and Urinary domains as key areas of concern, further emphasizing the need for targeted interventions. Participants reported enhanced mood, relaxation, and social connection, identifying these as the most valued aspects of the program. Recommendations include expanding access to mindfulness classes, offering tiered options for diverse skill levels, and integrating the program into standard Parkinson’s care. As a Doctor of Nursing Practice (DNP) )-led initiative, this project underscores the critical role of DNPs in implementing evidence-based, patient-centered interventions to address complex healthcare challenges.

Diabetes is one of the fastest-growing global health emergencies of the 21st century (IDF, 2021), with over 37 million Americans currently living with the condition (CDC, 2023). People with diabetes are at increased risk for mental health disorders such as diabetes distress, depression, and anxiety, which can worsen disease outcomes (ADA, 2021; Nouwen et al., 2019). These comorbidities heighten the risk of complications, hospitalizations, and mortality (Egede et al., 2010). However, a notable gap exists in primary care providers’ ability to address mental health concerns in this population (Jones et al., 2021). This Quality Improvement (QI) project aimed to enhance the identification and referral of individuals with diabetes to behavioral health services through a 10-week educational workshop for APRNs in a primary care setting. Guided by Jean Watson’s theory of human caring and the 7 A’s model from the ADA’s Diabetes and Emotional Health Practical Guide (Hendrieckx et al., 2021), the intervention emphasized a person-centered approach. Seventeen participants aged 25–64, employed by the Federally Qualified Health Center (FQHC) with integrated behavioral health services, completed the workshop. Post-intervention findings showed improved understanding of mental health disorders, greater familiarity with screening tools, and increased referrals to behavioral health. Significant growth in post-test scores highlighted the workshop’s effectiveness in achieving its objectives, demonstrating the potential for improving care for people with diabetes and comorbid mental health challenges.

Timely identification of palliative care needs in primary care is pivotal in improving patient outcomes and quality of life for individuals with chronic or life-limiting illnesses. Conversely, delayed recognition of these needs frequently results in missed opportunities for early intervention and comprehensive care planning. This quality improvement (QI) project focused on implementing the Supportive and Palliative Care Indicators Tool (SPICT) to enhance early identification and referral to palliative care within a primary care setting. The initiative sought to bridge care gaps by providing structured educational sessions to three medical doctors and five nurse practitioners. Participants received training on the SPICT framework and subsequently incorporated the tool into routine patient assessments. A pre- and post-intervention study design was employed to evaluate the intervention's efficacy. Data collection encompassed retrospective chart reviews to assess changes in referral patterns and provider feedback to evaluate the tool's practicality and usability. The analysis revealed a significant increase in early palliative care referrals and improved provider confidence in recognizing patients with palliative care needs. These findings underscore the value of integrating evidence-based tools like SPICT into routine primary care practice to enhance care delivery and patient outcomes. The project highlights the critical role of provider education in adopting standardized tools, emphasizing the broader implications for system-wide improvements in palliative care referrals.

Aims: The aim of this quality improvement project is to improve the quality of care for those with uncontrolled type II diabetes at the primary care facility (Palm Beach Family Medical Associates). The current standard of care of following up every 3 months is deficient in controlling HgbA1c. Literature and caring science supports an intervention with education and self-efficacy as the focus. Method: Apply evidence-based intervention of a diabetes education program with focus on self-efficacy and following up every two weeks on nutrition, exercise, weight management, and medical management. Participants are 45 years or older with uncontrolled Type II Diabetes with HgbA1c > 7.0. HgbA1c and Diabetes Management Self-Efficacy Scale is measured pre and post intervention and follow ups are completed over telephone calls.
Results: There was a significant (p < 0.05) decrease in both HgbA1c and DMSES values after intervention was completed.
Conclusion: Administering a diabetes education program with emphasis on self-efficacy and repetition through biweekly follow-up shows potential for improving HgbA1c and DMSES scores for those with uncontrolled diabetes (HgbA1c > 7.0). Many limitations are noted including loss of 40% of participants over time and application of program for only 3 months. Despite limitations, this quality improvement intervention shows promise in improving care for those with Type II diabetes.

Missed appointments disrupt care continuity, delay diagnoses, and decrease revenue in primary care settings. This quality improvement project at Meadow Clinic aimed to reduce no-show rates through evidence-based interventions targeting identified barriers such as forgetfulness, scheduling conflicts, and transportation issues. Participants included 72 patients with a history of missed appointments, who were surveyed to identify their preferences and challenges for adhering to office visits. The project used Jean Watson’s Theory of Human Caring and the Plan-Do-Study-Act framework (Appendix A) to guide the design and implementation of interventions: enhanced telehealth integration, personalized multi-modal reminders, and patient education on digital health tools. Quantitative and qualitative data were collected via electronic health records and surveys, analyzed using thematic analysis and descriptive statistics. Findings revealed that text reminders and telehealth significantly improved appointment adherence and patient satisfaction, while flexible scheduling addressed logistical challenges. Post-intervention, the clinic observed reduced no-show rates and increased telehealth usage. These results underscore the value of patient-centered strategies in improving access, operational efficiency, and healthcare equity. This scalable model offers practical implications for enhancing care delivery across diverse healthcare settings.

This evidence-based program evaluation assesses the effectiveness and patient adherence to a structured weight loss intervention at a local primary care clinic. The program targeted 21 adults, aged 27-60, with BMI ≥ 27 kg/m², many of whom faced cardiovascular risks. Over nine months, participants engaged in a program combining semaglutide injections, dietary guidance, behavioral counseling, and regular physical activity. Baseline and follow-up measures at three, six, and nine months evaluated outcomes alongside self-reported quality of life assessments. The results demonstrated significant reductions in BMI and weight (p < 0.01, CI: 95%), with participants reporting increased confidence and self-efficacy. The findings underscore the effectiveness of a nurse-led, compassionate primary care approach to weight management. Recommendations include extending follow-up periods and integrating demographic considerations (education, race, culture) to enhance adherence and long-term success. This evaluation provides actionable insights for clinic and broader healthcare contexts, with plans for dissemination through faculty presentations, publications, and local and national conferences.

This quality improvement initiative aimed to improve levels of compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) among Emergency Room (ER) nurses. This project was implemented during shift huddles in a busy urban city ER. Adopted from a previous study conducted by authors Tripathi and Mulkey in 2023 where the authors incorporated mindfulness-based self-compassion (MBSC) exercises based on the teachings of Christopher Germer and Kristin Neff (2019). The authors discovered a significant improvement in Professional of Quality of Life (ProQOL-5) scores in CS, burnout, and STS when MBSC was implemented (Tripathi & Mulkey, 2023). The project was implemented over four weeks. All staff attending shift huddles participated in a brief five-minute deep breathing mindfulness and self-compassion exercise. The brief exercises were led by the DNP student and three ER Assistant Nurse Managers (ANMs). Anonymous ProQOL-5 surveys were distributed before the project started and after the project was completed. There were 57 pre-survey responses, which included 49 nurses, six Paramedics, and two midlevel providers. The post-survey sample of 56 participants consisted of 44 nurses, eleven paramedics, and one midlevel provider. The “SMART” goal for this project was to achieve a 10 percent improvement in ProQOL-5 scores, this included the subcategories of CS, burnout, and STS. The “SMART” goal for this project was not met and there were no statistically significant changes in scores from the pre- to the post- ProQOL-5 surveys. However, external variables may have altered outcomes. Overall, more than three-quarters of the staff found the intervention enjoyable and wished leadership would continue to implement it, determining there may still be implications for nursing practice.

Skin cancer remains a significant public health concern due to limited knowledge of prevention and early detection. Late diagnoses contribute to substantial financial burdens and loss of life. This quality improvement project aimed to improve skin health outcomes and reduce serious diagnoses, such as melanoma, by increasing awareness of prevention and early detection strategies. Targeting a racially and ethnically diverse adult population in the Belle Glade community, the initiative promoted educational interventions, emphasizing modifiable behaviors such as regular sunscreen use and performing skin self-examinations (SSE). A total of 24 participants were recruited at community health fairs for this eight-week project. Pre- and post-intervention questionnaires assessed sun exposure habits, willingness to increase sun protection, and SSE practices. The mean pre-intervention SEPI tool I score was 14 (out of 32), indicating significant UV exposure and limited sun protection behaviors. Post-intervention, the SEPI tool II mean decreased to 4 (out of 20), reflecting an improvement in sun protection behavioral practices. Additionally, SSE adherence improved from 29.2% pre-intervention to 83.3% post-intervention, with sunscreen use rising to 87.5% by the project’s end. These findings demonstrate the effectiveness of providing education on the ABCDEs of melanoma, performing SSE, and implementing sun protection strategies. Promoting these behavioral changes can aid in preventing future melanoma diagnoses and facilitate earlier treatment, underscoring the importance of integrating such interventions in community health initiatives.

Background: Postpartum depression (PPD) remains a significant public health concern, often leading to adverse outcomes for both mothers and infants. The Edinburgh Postnatal Depression Scale (EPDS) is a validated screening tool that can facilitate early identification and timely referral for mental health services. At the community partner’s Health Department, low referral rates for mental health services among postpartum mothers underscored the critical need for a systematic and effective approach to screening and referral. Methods: Electronic health record (EHR) data from January to August were reviewed to assess baseline referral rates before EPDS implementation. After the introduction of EPDS screening in September, data from September to November were analyzed to assess its impact. A chi-square analysis was conducted to compare referral rates before and after the implementation of the EPDS screening protocol. Results: The analysis revealed a significant increase in the identification and referral of postpartum mothers at risk for PPD after the EPDS was implemented. The standardized protocol ensured timely intervention for mothers scoring above the threshold, with chi-square analysis indicating a strong association between EPDS screening and higher referral rates for mental health services (Pearson Chi-Square = 37.534, df = 1, p < 0.001). Conclusion: The integration of the EPDS screening tool at the community partner’s Health Department significantly enhanced the identification of postpartum mothers at risk for PPD and facilitated timely referrals to psychiatric or psychological support. This quality improvement initiative underscores the importance of incorporating validated screening tools into routine care to improve mental health outcomes for postpartum mothers.