Christine E. Lynn College of Nursing

Telemedicine is a more beneficial technology that can make it easier for people to get preventive treatment and help their long-term health. Missed appointments are detrimental to clients’ health, create scheduling problems, reduce productivity, increase healthcare costs, cause revenue loss, and diminish access to adequate healthcare for clients who could have been seen in the unused appointment slots. Non-adherence to medication is another area of concern associated with poorer prognosis and incremental differences in treatment cost. By examining the efficacy of telehealth services in maintaining treatment adherence among ethnic minority populations, this project aimed to shed light on how digital healthcare platforms can serve as vital lifelines, ensuring continuity of care and supporting the journey toward recovery and well-being. The project evolution was based on the author’s clinical setting (P.I.R.C.), where numerous cancellations and no-shows for medication management appointments have occurred. Many clients may not have been aware they could have requested a telehealth visit instead of canceling or missing their appointments. The clinical site’s external organizational threats included a significant financial loss due to the high number of cancellations or no-show rates. The author’s scholarly clinical project focused on leveraging telehealth consultations to decrease no-show rates for medication management appointments. This project taught participants how to download and use the Telehealth app on their phone or computer, as well as how to reschedule their in-person appointment and log into the Telehealth app on the scheduled appointment date. An evaluation questionnaire was used for post appointment cancellations to determine the reasons why the appointments were canceled, if the client received a reminder to confirm their appointments prior to canceling, and questions concerning the stakeholder’s technological knowledge on how to use the telehealth service. The participants received a video tutorial with directions on how to access the telehealth visit via their clients’ portal. At the end of that first telehealth appointment, a post-questionnaire was given to assess the ease or difficulty encountered during the visit. After collecting the pre- and post-questionnaires, the data was analyzed by comparing the client cancellation or missed appointment rates before and after the intervention, an evaluation questionnaire was used to compare the client satisfaction scores before and after the intervention. The dissemination plan was shared with the participants, staff members, and leadership at the author’s clinical site, FAU students, and supervising faculty to help improve their cancellation rate.

Upper respiratory infections (URIs) are among patients' most common complaints in an urgent care setting. URIs involve upper airway structures and include the common cold, pharyngitis, sinusitis, and more. These complaints are of a viral nature and typically require symptomatic treatment with over-the-counter (OTC) medications to improve patient comfort. Depending on comorbidities, medication interactions, and allergies, medical providers typically recommend similar products for each URI. However, the sheer volume of available products makes selecting difficult for patients. Many patients get overwhelmed when given verbal recommendations and frequently need to remember information discussed in the office. Several studies have previously shown that visual aids can improve patient understanding and retention of information, satisfaction, and patient health outcomes. This quality improvement project used a visual pamphlet to improve patient education and self-care management. English-speaking patients aged 18 to 95 with symptoms of a URI were included in this quality improvement project conducted in urgent care in the Treasure Coast area. A chart review and survey via phone call were utilized to collect data on patient satisfaction, pamphlet use, and self-care improvement. Collected data was analyzed via Research Electronic Data Capture (REDCap), and results clearly showed that patients’ self-care improved and were very satisfied with the care given. Future use of a visual education pamphlet about self-care for an upper respiratory infection is recommended.

This Doctor of Nursing Practice (DNP) project was to enhance primary care providers' self-efficacy in delivering effective care to neurodivergent adults. Despite the growing recognition of neurodivergence, many primary care providers report feeling inadequately prepared to meet the complex healthcare needs of autistic patients, resulting in barriers to care, miscommunication, and suboptimal health outcomes. This project sought to address these gaps by integrating a comprehensive, evidence-based educational resource, Clinical Care for Autistic Adults, into a professional development initiative for primary care providers. The course covers critical topics such as understanding autism spectrum disorder (ASD), recognizing co-occurring health conditions, effective communication strategies, and promoting patient-centered care. Providers participated in the course and completed pre- and post-intervention A.A.S.P.I.R.E surveys to assess changes in their knowledge, confidence, and attitudes regarding the care of autistic individuals. Findings indicated significant improvements in providers' self-reported self-efficacy. The results suggested that implementing education such as the Clinical Care for Autistic Adults can improve providers self-efficacy by helping to equip providers with the tools necessary to navigate a growingly diverse patient population.

Skin cancer is a prevalent malignancy in the United States, with disparities in outcomes notably affecting individuals with skin of color (SoC). To avoid the assumption that "skin of color" refers solely to African Americans, skin of color also includes individuals of Asian, Hispanic/Latino, Mediterranean, Middle Eastern, Pacific Islander and Native American descent. While the incidence of skin cancer is lower among Skin of color, late-stage diagnoses contribute to greater morbidity and mortality compared to lighter-skinned populations. This DNP quality improvement project aims to enhance skin cancer awareness and self-assessment practices among SoC in Belle Glade, Florida, a predominantly underserved rural community. Leveraging culturally tailored educational interventions, the project includes a multimedia approach combining educational brochures and a video featuring diverse skin tones and anatomical visuals of skin cancer lesions. Guided by Madeleine Leininger’s Culture Care Theory and the IHI Plan-Do-Study-Act framework, this initiative seeks to address health inequities by improving knowledge about prevention, detection, and self-advocacy. Participants were recruited through a health fair, where pre- and post-intervention surveys measured changes in skin cancer knowledge and self-assessment behaviors. Anticipated outcomes include increased awareness of skin cancer risks, adoption of self-assessment practices, and improved resource awareness for SoC individuals in the community. The project's broader goal is to bridge the gap in dermatological care disparities, fostering sustainable changes in patient education and health literacy while addressing systemic inequities in skin health outcomes. Results will inform future interventions and contribute to a more inclusive approach to skin cancer prevention and treatment.

The purpose of this quality improvement initiative was to improve sleep quality and reduce insomnia severity in individuals diagnosed with insomnia. This project was completed with 11 total participants, in which smartphone-delivered cognitive behavioral therapy for insomnia (i.e., CBT-I Coach) was utilized four or more days out of the week. The project spanned the course of six weeks. Insomnia severity was measured using the Insomnia Severity Index (ISI) and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI). The General Self- Efficacy Scale (GSE) was also utilized to evaluate participants general self-efficacy. Questionnaires were administered pre and post intervention. Additionally, a self-developed CBT-I utilization questionnaire was administered at weekly check-ins. The results yielded a mean decrease of 57% for PSQI scores and 50% for ISI scores, as well as a mean increase of 17% on GSE scores. The results confirm that smartphone delivered CBT-I is a beneficial tool in improving sleep outcomes for individuals suffering from insomnia. Mobile CBT-I has significant implications for enhancing patient care and evolving current healthcare practices, particularly for the treatment of insomnia.

This QI project assessed the effectiveness of scripted follow-up telephone calls in improving patient satisfaction and reducing no-show rates at my project site. This project aimed to identify whether maintaining caring-based communication patterns could produce patient involvement and clinic functional efficiency improvements using a pre- and post-intervention design. This study presents qualitative data collected from 13 patients before and after the intervention, which involved receiving scripted monthly phone calls. The results showed that although patient satisfaction scores remained stable, it was impossible to attribute the improvement fully. The mean satisfaction scores increased from 6.33 before the intervention to 22.54 and 19.00 60 days later. Missed appointment rates remained elevated, with an average of 2.08. The study discovered no statistically significant link between missed appointments and satisfaction scores. This suggests that external factors influenced patient compliance, as evidenced by paired sample t-tests and correlation analyses in SPSS.
The intervention, therefore, did not bring forth significant improvements in patient satisfaction or compliance but established the capacity for follow-up calls to strengthen satisfaction and patient commitment. The study concluded that individualized and integrated communication improved patient-clinician relationships, decreased no-show rates, and enhanced clinic productivity. Future communication strategies should include a variety of outreach methods and address logistical challenges in order to maximize their impact on patient outcomes and clinic operational efficiency.

In February of 2024, eleven Florida Atlantic University (FAU) nurse practitioner (NP) students arrived in Guatemala to participate in a medical mission trip led by two clinical professors from the Christine E. Lynn College of Nursing (CON) in conjunction with the non-profit organization, Nursing Heart Incorporated (NHI). The collaboration between NHI and FAU allows NP students to assess, evaluate, and treat residents living in rural and underserved communities outside of Antigua and to receive primary care and women’s health services. The conditions in these communities were austere. In previous mission trips to Guatemala, the NP students expressed interest in improving their proficiency at diagnosing common vaginal infections based on signs and symptoms with unaided visual inspection and improving their microscopy skills to help solidify their knowledge of common vaginal infections. Data were collected using a pre- and post- immersion survey and post-immersion reflective questionnaire. At the outset of the QI project, the objective was to have a 25% increase in confidence levels in pre- versus post-surveys; the results showed confidence improvement ranging from 8.33% to 39.39% in every aspect surveyed. The NP students noted a subjective increase in their confidence in their clinical and microscopy skills. The success of this QI project suggests increased practice in performing pelvic speculum exams, and the addition of education in microscopy evaluation improves NP students’ confidence in recognizing, diagnosing, and treating common vaginal infections. These skills are particularly valuable for NP practitioners who will be practicing in rural and low-resource settings. The quality improvement project aimed to improve the current program by enhancing the pre-mission PowerPoint presentation, visual aids, standardized specimen collection, and microscopy analysis training to increase the NP students' confidence level in visual assessments.

The Neonatal Intensive Care Unit (NICU) is an inherently stressful environment for parents, where their satisfaction is a critical indicator of the quality of care provided. However, limited research has explored the satisfaction levels of Saudi fathers and mothers in the NICU, which are influenced by Islamic cultural values, family dynamics, and societal norms. A convergent parallel mixed-methods design was employed to explore the differences between Saudi fathers and mothers by integrating quantitative data on satisfaction with qualitative insights from NICU parental experiences of satisfaction through the lens of Leininger’s Culture Care Theory (CCT). Quantitative data were collected through a cross-sectional descriptive correlation design using the Critical Care Family Satisfaction Survey (CCFSS), adapted for the Saudi context. Qualitative data were gathered through an ethnonursing design involving participant observations and semi-structured individual interviews. The study included 75 parents (34 fathers and 41 mothers) from King Fahad Medical City in Riyadh, Saudi Arabia. Quantitative data were analyzed using independent t-tests, while qualitative data (25 observations and 22 interviews) were analyzed according to Leininger’s four phases of the Data Analysis Enabler. The mixed-methods analysis employed a side-by-side comparison to present both findings in a parallel format.

Transitions in care have been a national priority for decades to promote the safe and timely passage of patients between levels of healthcare and across care settings. Improving hospital discharge processes is an important quality improvement initiative to reduce adverse outcomes, and thirty-day readmission rates and increase patients’ satisfaction after discharge. This qualitative design study explored the perceptions, experiences, and gaps in understanding the needs of the resident and family in the transition from a hospital to a skilled nursing facility (SNF). It is essential to understand the perspective of the residents, families, and healthcare professionals who experience this transitional process to inform future research, and practice initiatives and to effectively prepare the residents and families for this transition. The purposive sample included 15 residents, 13 family members, and 12 SNF staff. The setting was a SNF within a continuing care residential community with an 89-licensed-bed capacity in Palm Beach County, FL. This doctoral research applied a descriptive qualitative methodology to capture the essence of the perceptions of residents, families, and staff participants transitioning from acute care to a skilled nursing facility. Interviews were qualitatively analyzed with an interactive model utilizing open, pattern, and thematic coding, and data (network) display to help organize, inform, and justify conclusions and explanations. Overall, 53% of residents, and 62% of families expressed confusion, frustration, concern, uncertainty, disappointment, and stress.

The purpose of this study was to assess the levels of posttraumatic growth (PTG) and ease and examine the relationship between PTG and ease among the Bahamian population who experienced a trauma cluster. A descriptive, cross-sectional, quantitative design was conducted on the island of Grand Bahama, Bahamas, nearly 4 years after the trauma cluster of Hurricane Dorian and the Coronavirus disease pandemic. A convenience sampling method was adopted, and 208 adult survivors of the trauma cluster completed the survey. The 21-item Post-traumatic Growth Inventory (PTGI) scale and Ease Measure were used in the assessment of PTG and ease, respectively.
The mean total score for the PTGI was 73.68 (SD = 21.38), and the percentage of individuals with moderate-to-high PTGI scores was 77.4%. A general linear model repeated measures test (within-subjects factor) was used to compare the average total mean scores (range 0–5) of each of the five PTG subdomains. Results revealed there was a significant difference between each of the five subdomains [F(1, 207) = 180.37, p < .001] except for the difference between “appreciation of life” (M = 3.97, SD = 1.11) and “spiritual changes” (M = 3.94, SD =1.32) which had the highest average mean scores followed by “personal strength” (M= 3.73, SD = 1.10) “new possibilities” (M = 3.26, SD = 1.20) and “relating to others” (M = 3.19, SD =1.15). The mean score for ease was 59.72 (SD = 9.25). A Pearson’s correlation revealed there was a significant but weak, positive correlation between the PTGI-total and ease r(206) = .266, p < .001. Further investigation into the relationship between PTG and ease revealed there were no significant findings for PTG according to different sociodemographic characteristics or trauma cluster outcomes. However, there were significant findings for ease according to different age groups and multiple trauma cluster outcomes. Further research is needed to continue to uncover the conditions and approaches that give rise to PTG and ease. The knowledge gained can be used to create interventions to promote positive responses that lead to improved well-being, life satisfaction, and the ability to thrive after these disastrous events.