Christine E. Lynn College of Nursing

“Out of the 17 million global deaths per year that result from cardiovascular disease, 9.4 million are due to hypertension” (Zinat Motlagh et al., 2016). Hypertension is a chronic disease that has been a major public health concern, leading to further complications including stroke, cardiovascular, and kidney disease. The purpose of this QI project was to both better comprehend hypertension management in the primary care setting and improve patient self-care behaviors. The participants for this project were recruited from a list of patients selected after reviewing patient charts along with the community leader. Those patients who were previously diagnosed with hypertension were specifically selected.
The survey used to assess the patients was the The Hypertension Self-Care Activity Level Effects (H SCALE), which assesses the six prescribed self-care activities recommended by the JNC7: adherence to medication, weight loss or maintenance of ideal body weight, adoption of a low-salt diet, regular physical activity for 30 minutes most days of the week, limiting alcohol intake, and ceasing tobacco use.” (Warren-Findlow & Seymour, 2011). A total of nine individuals participated in this project over the span of three months. Post intervention scores for majority of the participants (88.8%) revealed an overall decrease in blood pressure readings post intervention.

When treating and studying mental health we must identify all of the factors that play a role in mental stability. Basic needs such as access to water, food, and resources can play a significant role in mental stability and can increase or decrease the likelihood of triggering, exacerbating, or eradicating a mental illness. Human beings need their basic needs met in order to have a healthy foundation and tackle mental and medical disorders. Scholarly evidence shows a positive correlation between food insecurity and moderate to high levels of psychological distress. Inadequate access to food increases the probability of disorders, psychotic breakthroughs and/or exacerbation of psychiatric illnesses. Individuals with mental health disorders are at risk for poor food security. The DNP project created and implemented for quality improvement assess clinicians’ willingness to implement the Food Insecurity Experience Survey (FIES) in an adult inpatient psychiatric stabilization and residential setting after the completion of an educational program. Project evaluation involved the Evidence-Based Practice Assessment Survey (EBPAS), a pre- and post-test surveys on FIES knowledge, and a post-test on the usefulness of the educational program. Analysis revealed significance improvements in the Openness, Appeal, and Requirements subscales of the EBPAS. Items on the pre- post-test survey on FIES knowledge were statistically significant. Likewise, the results revealed significant satisfaction with the educational program. Facilitators of the project concluded that the project outcomes illustrate the utility of an educational program on the implementation of FIES for food insecurity screening in mental health settings.

Background: Hypertension (HTN) is one of the leading causes of death in the United States. It is an all too common disease that goes unnoticed and untreated until it is too late. African American adults suffer from uncontrolled hypertension at a disproportionate rate when compared to their Caucasian or Latinx counterparts, and hypertension continues to be a persistent issue within a primary care setting when dealing with this population.
Purpose: This Doctor of Nursing Practice (DNP) project assesses the effectiveness of combating hypertension by giving participants the knowledge to improve their condition, continually monitoring blood pressure, and providing counseling at various follow-up sessions. The primary goal of this project was to decrease the blood pressure of all participants and increase participants’ education on how to better manage their condition.

Background: Every year, 2% to 10% of pregnancies in the United States are affected by gestational diabetes (CDC, 2021). Gestational diabetes is a common complication in pregnancy, affecting millions of women annually. Among women with diabetes with suboptimal glycemic control, the risk of stillbirth, congenital disabilities, and preterm birth in the third trimester is considerably higher than their standard counterparts. This project aims to implement a diabetes education program for pregnant women newly diagnosed with gestational diabetes to improve outcomes.
Methods: Nine recruited participants consented to participate in the program. Each participant was given a Diabetes Empowerment Scale before an education session as a pretest. In addition, all nine participants were provided with a curated educational packet and teachings in their primary language during the session. After the education, the participant completed the Diabetes Empowerment Scale as a posttest to evaluate the participant’s psychosocial self-efficacy toward diabetes.

Type 2 diabetes is a public health challenge. Researchers at the center of disease control and prevention (CDC), report more than 34 million Americans have diabetes (about 1 in 10) (CDC, 2019). Uncontrolled diabetes over a long period of time can result in end-organ damage. End results of poor glycemic control can result in diabetic retinopathy, neuropathy, kidney disease and kidney failure (Sacks, 2017). In type 2 diabetes (T2D) cells do not respond normally to insulin, a condition known as insulin resistance. These results set the stage for pre-diabetes and type 2 diabetes. Type 2 diabetes often develops in people over age 45, but more recently children, teens, and young adults are also developing type 2 diabetes. Type 2 diabetes in children are rising due to obesity rising. According to the CDC, more than 75 % children with type 2 diabetes have family members who also have it (CDC, 2019). With this being said, many evidence based research studies reveal how diabetes self- management is influenced by one’s confidence and willingness to manage diabetes. The patients desire to enhance their knowledge, skills and confidence is referred as “Patient Activation.” Increasing patient activation will help people manage their diabetes more effectively and be active in self-management behaviors (Regeer, Van Empelen, & Bilo, 2021).

Type 2 Diabetes Mellitus is a fast-growing global problem with vast social, health, and economic consequences. Approximately 382 million people worldwide have been diagnosed with the disease, and this number is expected to increase by 55% by 2035. Diabetes is the seventh leading cause of death in the United States. More than 34 million Americans have diabetes, including 2.4 million cases in Florida. The goal of this project was to improve the effectiveness of diabetes self-management information on selection of healthy carbohydrate-containing foods and blood glucose monitoring in a group of adults with uncontrolled type 2 diabetes receiving care in a primary care setting. Education from the National Diabetes Education Program using the 4 Steps to Manage Your Diabetes for Life along with follow up phone calls, a pre- and-post Diabetes Self-Management Questionnaire (DSMQ) were administered to ten participants (6 females and 4 males 64-85 years of age) at a primary care site. Descriptive statistics and paired sample T-tests were used to analyze data on the DSMQ pre-and post-intervention. Results were statistically significant and showed that selection of healthy carbohydrate-containing foods and blood glucose monitoring increased in all ten (100%) participants from pre to post intervention. Data analysis showed that the pre-mean selection of healthy carbohydrate-containing foods was 5.3 out of 12 (SD, .675) and a post mean of 10.4 out of 12 (SD, .843) [t(9) = 16, p<.001. In addition, data analysis showed the mean of blood glucose monitoring increased from 4.4 out of 15 (SD, 1.075) on the pre-test to 12.3 out of 15 (SD, .675) on the post-test [t(9) = 18, p<.001]. The increase in the scores reflect the participants’ ability to choose foods that are congruent with healthy eating habits. It is strongly recommended that the 4 Steps to Manage Your Diabetes for Life booklet be used in practice to improve patients’ knowledge and self-management behaviors regarding diabetes.

Aim: In the United States, prenatal depression is an underdiagnosed mental health disorder that can result in complications for the mother and fetus. Approximately 7 to 12 % women are affected by prenatal depression (Sidebottom et al., 2021). African American women experience more stressors during the prenatal period which places them at a higher risk for depression than other racial groups (Liu et al., 2016). Early screening can help identify and treat prenatal depression which may reduce the risk of postpartum depression. The purpose of this quality improvement project (QI) was to screen African American pregnant women, using the Edinburgh Postnatal Depression Scale (EPDS), to determine if screening for depression prenatally can initiate early treatment and referral.
Method: All pregnant women who received prenatal care at a women’s health clinic were screened, using the EPDS, for depression prenatally. Relationships and differences between mother’s demographic variables and their EPDS scores were explored using the Pearson Product Moment Correlation and Analysis of Variance (ANOVA). A one-time follow-up telephone interview was conducted, for education and support, 3-4 weeks post completion of the EPDS.

Cardiovascular disease is a serious health condition that affects the blood flow to and from the heart. It is currently one of the leading causes of death globally as it accounts for approximately 32% of deaths each year (WHO, 2021). In Palm Beach County, cardiovascular disease is the leading cause of death accounting for 23.7% of overall deaths (Palm Beach County, 2022). The risk for developing this disease increases when other comorbidities exist such as diabetes, hypertension, hyperlipidemia, or an elevated Body Mass Index (BMI). With proper knowledge and lifestyle modifications, risks from complications are lowered. It is for this reason that a QI project was implemented, to see if a community prevention program (CPP) could help improve knowledge and behavior changes within a population. Overall, six participants completed the program, three males, and three females. Results showed that 83% of participants lowered their HgA1c while there was a 100% increase in blood pressure. Results also showed a decrease in BMI for 33% of participants, and an increase in BMI for 17% of participants. Overall cholesterol decreased by 66%. Based on the self-efficacy survey that participants took, it appeared that they were more confident and likely to identify healthy food choices and increase their aerobic exercise and activities. Although initial goals were not fully met, the implications of this project showed that a CPP can improve certain biomarkers that could help reduce the risk of cardiovascular disease. A longer period of time and larger sample size might yield much different results. It would also be beneficial to trend certain biomarkers such as BMI and blood pressure multiple times throughout the duration of the program to determine if a change occurs over a longer period.

In 2019, the leading cause of death in the United States was cardiac disease associated with high blood pressure. High blood pressure has had profound consequences on people’s lives leading to stroke and even death. As a preventive measure, providers have encouraged lifestyle changes in order to help alleviate the burden of this condition. One of these consist of altering eating habits to a strictly plant-based diet. With the help of Doctor Sarah Long DNP, ten participants suffering from high blood pressure have volunteered to alter their eating habits for four weeks to further demonstrate the efficacy of plant-based diets. Thanks to Nola J. Pender’s Health Promotion Model and a paired t-test, this project was able to provide additional insight on the efficacy of plant-based diets while analyzing the participants’ willingness to alter their lifestyles for health promotion purposes. The results further demonstrated the effectiveness of plant-based diets by successfully assisting nine of the ten participants in lowering their blood pressures.

In 2018, 50 million people were living with dementia worldwide, and this number is expected to increase to 82 million by 2030 (Novotny et al., 2018).
The aim of this quality improvement project was to assess Certified Nursing Assistants’ (CNAs) dementia knowledge, self-efficacy in establishing caring relationships, and attitudes toward people living with dementia. In addition to sociodemographic data, measures used to guide development of the education intervention included questions from three measures; the Dementia Knowledge Assessment Scale (DKAS), Dementia Attitudes Scale (DAS), and Caring Efficacy Scale (CES).
The results of the project demonstrated a need for further education of CNAs regarding health promotion strategies to reduce the risk of developing dementia and strategies for those already experiencing dementia. There was also an identified need for education regarding best techniques for communicating with people experiencing dementia, and ways in which those experiencing dementia communicate with those in their environment, including manifested behaviors. These survey results are intended to be used to build a web-based asynchronized and on-demand course to meet these educational gaps. and further improve the understanding and care of those experiencing dementia within the workplace of the CNA.