Christine E. Lynn College of Nursing

Dementia, Alzheimer’s disease, and other neurocognitive disorders causing memory loss in the older adult population has substantial implications on one’s physical, mental, social, and economic well-being. This quality improvement project aimed to evaluate the perceptions of current resources in place and what educational needs exist for police officers when providing care to older adults with dementia. The project intervention included an evidence-based online survey intended to assess police officers’ sociodemographic information, previous exposure to dementia training, participants’ baseline dementia knowledge, general caring beliefs, and attitudes toward individuals with dementia. Most (97%; n = 28 of 29) respondents completed the surveys. Over half (64%) of respondents admitted to never receiving specialized training for dementia and 61% of respondents admitted to knowing someone in a professional setting with dementia. The overall average score of the Dementia Knowledge Assessment Scale (DKAS) questions was 76%, but there were 5 total questions that were answered correctly by less than 60% of respondents. The lowest scoring domains of questions from the DKAS included the “Communication and Behavior” domain and the “Risks and Health Promotion” domain. The data was interpreted and recommendations were made to inform the development of a 20-hour continuing education certificate course for first responders entitled, “Compassionate Care of Older Adults at Risk for Dementia.” The project results demonstrated the lack of formal training in dementia among police officers and emphasized areas of strength and areas of opportunity to learn more about caring for those with dementia. This project holds future application for learning about dementia among other first responder disciplines, such as firefighters or paramedics, including the administration of a post survey following the pilot program of the first responder continuing education certificate course.

The purpose of this Doctor of Nursing Practice (DNP), quality improvement (QI) project was to increase heart disease risk awareness while implementing healthy lifestyle behaviors in Hispanic women between the ages of 30-65. The literature presents that all women are at risk for cardiovascular disease (CVD); with ethnic minorities being disproportionally affected. Following recruitment, participants attended a weekly wellness program guided by the Pasos Adelante curriculum over a 12 week period. Lifestyle behaviors were assessed by using the Health Promoting Lifestyle Profile II (HPLP II) questionnaire, CV knowledge was assessed with a brief true or false questionnaire, and the Godin-Shephard Leisure Time Exercise Questionnaire (GSLTEQ) was used to measure physical activity. The results of this DNP project showed an increase in CVD risk knowledge and an increase in physical activity.

Background and Review of Literature: Palliative care has a high potential to increase quality of life for patients with serious illnesses through symptom management and providing care and support. There are various settings and organizations where individuals can receive such care. Still, many people prefer staying at home in a familiar environment. The problem is that palliative care programs should be effective to justify the resources invested and maintain patients' quality of life. Moreover, as literature review shows they should involve advanced practice registered nurses (APRN) to achieve better outcomes since these specialists have considerable skills and competencies, but their potential is not used to the fullest.
Purpose: The current DNP project is aimed at evaluating the palliative care program provided by Prospero Health to confirm its compliance with the goals of adequate care. Moreover, the project assesses the strengths and weaknesses of the project, identifies barriers to its implementation, and assesses the effectiveness in a decrease of hospitalizations. Another goal is to provide recommendations to improve the performance of the Prospero Health program based on the evaluation results.

The current generation of youth may be the first in the United States who dies sooner than their parents and lives sicker. Stereotyping and discrimination may degrade communication between overweight/obese patients and their providers, exacerbating this negative trend. The purpose of this quality improvement project was to determine if participation in online support groups is an effective tool to assist obese young adults in weight management. Six participants followed a low-calorie diet (1500 cal/day for women and 1800 cal/day for men) and engaged in 30 minutes of daily exercise. All participants also filled out the Obesity and Weight Loss Quality of Life (OWLQOL) questionnaire before and after the project to determine improvements in overall sense of well-being. Additionally, half of the participants joined an online support group by the name of Overcoming Obesity through Facebook. The effectiveness of the project was determined by comparing weight loss results in participants who joined the online support group versus those dieting and exercising on their own. Results showed that participants who joined the online support group lost more weight and felt better about themselves compared to those who dieted on their own. In primary care practice, providers can recommend online support groups to young adults struggling with weight management due to it being easily accessible and giving participants the opportunity to express themselves without fear of judgment.

Heart failure (HF) is a global epidemic that affects older populations at an unprecedented rate. It is one of the leading causes of hospital readmission in patients 65 years and older. Although many strategies have been used to properly manage the disease, HF remains a complex condition due to several factors such as disease progression, comorbidities, inadequate patient knowledge, and non-adherence to the treatment plan. Despite the impact of HF on quality of life, morbidity, and mortality in older adults, they have been markedly underrepresented in most major cardiovascular trials. Besides the use of traditional methods for HF management, studies have shown that telehealth can be an effective strategy to provide the necessary education and assistance to patients, reducing the need for unnecessary ER visits. A quality improvement (QI) project involving 10 participants diagnosed with HF was implemented from June to September 2022. The aim of this project was to measure the effect of a telehealth-based HF program on HF knowledge, self-care adequacy, and hospital readmission among patients ≥ 65 years diagnosed with HF. To achieve this objective, a system including remote symptoms monitoring along with weekly education sessions on HF self-management was implemented. After using measurement tools (Dutch Heart Failure Knowledge Scale and Self-Care Heart Failure Index) and analyzing data, a statistically significant improvement (p< .001) in HF knowledge and self-care adequacy, and a decrease overall in hospital readmissions over a 3 month-period was noted. However, due to certain limitations such as small local sample size, unintended bias, and lack of diversity among participants, the results could not be generalized, and further experimental studies were warranted. Although we value the importance of telehealth, we strongly encouraged in-person visits for thorough physical examination, and we educated patients to identify red flags that warrant a visit to the emergency.

As the rate of diagnosed diabetes continues to increase in minority ethnic groups, especially African Americans (AA), the need to implement a diabetes self-care program for African Americans with type 2 diabetes was the purpose of that quality improvement project. The participants were recruited from Duhaney Medical, a private practice in Boca Raton, Florida. All the participants were current patients of Dr. Duhaney, the practice owner. The project lasted eight weeks and all communications happened via phone calls and emails. The participants received via email four different narrated PowerPoint presentations about diabetes. The Diabetes Knowledge Test (DKT) and the Diabetes Self-Management Questionnaire (DSMQ) were used to explore the participants’ knowledge and their diabetes self-management as it relates to glucose management, dietary control, physical activity, and healthcare use. The project started with 15 participants, but five withdrew. The age of the remaining ten participants (N=10) ranged from 32 to 75 years old, with more females (80%) than males (20%). The p-value for the DKT was 0.1879 and was not statistically significant. On the other hand, the DSMQ was statistically significant with a p-value of 0.0061. The mode of each item from the DSMQ were analyzed and the findings revealed that the participants understood and applied the appropriate activities for their diabetes self-care. Thus, the project proves that self-management programs are advantageous to patients’ well-being. As a result, more research should be conducted to reinforce the importance of diabetes self-management among AA while preparing the healthcare providers to facilitate that teaching.

Postpartum depression (PPD) is a very common medical condition, which can be very dangerous, if left untreated. According to CDC, one in every eight women experiences postpartum depression (CDC, 2020). It has been drawing a lot of medical attention more recently in some of the countries, including the USA. This is caused by the debilitating effects it has on the mother, her bonding with the infant, the family as a unit, as well as other factors. In certain countries, such as the countries of the former USSR, PPD is not considered to be a legitimate medical condition. Therefore, many women from those counties are not properly educated on the causes, symptoms, effects, and treatment for PPD. They do not receive proper support and treatment. The intention of this quality improvement project is to screen women for this condition, educate, treat, and follow up using text messages, calls, and video conferences. These steps should improve women’s knowledge about PPD, their quality of life, their ability to seek treatment, and their condition.

Background
Potentially avoidable nursing home-to-hospital transfers can cause harm to vulnerable residents and are costly (McCarthy et al., 2020). Nursing homes (NH) with an effective hospital transfer prevention program (HTPP) have been shown to keep residents safe, improve health outcomes, and control healthcare expenditures (McCarthy et al., 2020). Studies have shown that many hospital transfers can be avoided with evidence-based interventions (Ouslander et al., 2014).
Aim
This program evaluation aims to examine the current HTPP at a nursing facility in South Florida to determine its effectiveness in decreasing hospital transfers by evaluating the use of the interventions in place and the number of hospital transfers each quarter in one year.

Mental health conditions such as depression and/or anxiety can be improved through music therapy. In a few studies of patients undergoing invasive procedures, music therapy appeared to reduce depressive symptoms and anxiety levels (Aalbers et al., 2017; Padam et al., 2017). The objective of this clinical quality improvement project was to evaluate the role of music therapy in reducing the anxiety scores among patient with suspected chronic GERD, achalasia, or dysphagia undergoing an invasive procedure such as an esophageal manometry study. The risks to the participants were no different than patients that are currently receiving standard care. Project participants were recruited from our Neurogastroenterology & GI Motility practice. They were all 18 years of age or older, male or female, and had a diagnosis of chronic GERD, suspected achalasia, or dysphagia.
Patients completed the short version of the State and Trait Anxiety Inventory (STAI) questionnaires (the definitive instruments for measuring anxiety in adults). The objective markers such as vital signs (blood pressure, temperature, heart rate, pulse, and oxygen saturation) were collected before and after the intervention. The focus of data collection was on the essential qualities evaluated by the STAI-State (STAI-S) Anxiety scale, which are feelings of apprehension, tension, nervousness, and worry (Spielberger, 1983). Pre- and post-test scores were analyzed by conducting a paired t-test with the Intellectus statistical program to assess differences in pre- and post-anxiety scores of patients’ receiving “comfort talk” standard care versus music therapy.

Open-heart surgery is one of the most frequently performed surgeries in the United Sates. Despite advances in techniques, there is still a significant number of complications leading to readmission. As of 2021, the national pooled 30-day readmission rate was 12.9% (95% CI: 11.3-14.4%). Various studies report rates of 30-day readmission from 8% to 21%, thus making open-heart surgery a target to achieve value-oriented health care milestones by policymakers. A program evaluation was conducted via chart review to compare the rate of readmission of a local cardiothoracic program to the national average. The program focuses on early follow-up post discharge and direct communication and access to the team (surgeon and advanced practice providers). A total of 98 patient charts were reviewed and the rate of readmission was calculated to be 6.1%. There was also a 3.1% rate of emergency room visit without readmission noted. Due to the significant different between these percentages, it is recommended that the team shares their processes to develop a clear protocol for other teams in the area to adopt into their practice.