Christine E. Lynn College of Nursing

Low health literacy can lead to a lack of disease perception or understanding of one’s disease process, treatment plan, and state of health, which could potentially lead to nonadherence, further health disparities, and poor health outcomes (Hugtenburg et al., 2013). The purpose of this project was to evaluate whether an online platform that provides Hispanic patients with evidence based and culturally sensitive diabetic education and support in the form of a video, would improve adherence and health outcomes. Upon the completion of the 3-month program that consisted of bi-weekly check-ins, results showed that there were overall improvements in the participants’ fasting blood glucose, systolic and diastolic blood pressure, body mass index, Diabetes Self-Management Questionnaire (DSMQ) scores, and A1C.

Suicide is one of the most serious public health issues in the US today. Suicide is of particular interest because it is the tenth leading cause of death for all ages in the United States, the second leading cause of death in ages 10-34, and the fourth leading cause of death in ages 35-54 (CDC, 2020). Despite national goals to lower the suicide rate, several recent reports have documented a steady increase in suicide rates in recent years. Suicide rates continues to rise in almost every state. The purpose of this manuscript is to describe a quality improvement project (QI) that was carried out to increase knowledge and use of a Mobile Health Applications Safety Plan (MHASP) to reduce the risk of suicide. The need for this project was identified at an outpatient clinic where patients at high risk for suicide were not receiving printed completed safety plan or enhanced instruction. Several studies identified potential barriers to adherence including complexity of treatment, low health literacy, and persistent symptoms while other studies displayed the positive impact of enhanced instruction on reducing the risks of suicide. This QI project lasted 6-week period and included a telehealth intervention that used verbal instructions and teach-back to improve knowledge. Participants filled-out surveys before and after intervention. Despite the small sample size, all the participants showed improvements. Based on these findings, the outpatient clinic was advised to continue reinforcing knowledge of the mobile suicide safety plan application and to incorporate a telehealth follow-up program to emphasize proper application use for these patients. Future projects and research should focus on larger sample sizes over longer periods of time as well as tracking suicide risks and outcomes.

Background: The prevalence of Type 2 diabetes is substantially significant in the United States and has been this way for several years. Diabetes is a complex, chronic disease that, without proper control, may result in avoidable complications. Once the diagnosis of diabetes is made, it is critical to establish clear treatment goals on increasing knowledge, self-efficacy and enhancing self-care. Implementing a program that supports self-care strategies for adults with diabetes to help achieve optimal health outcomes. For US adults aged 18 years or older the prevalence of diagnosed diabetes in non-Hispanic blacks is 12.1% which is the second highest (CDC,2019).
Purpose: The purpose of this study is to determine if a PowerPoint presentation in Haitian Creole on diabetes self-management will improve self-efficacy, diabetes knowledge and management among Haitian patients with type 2 diabetes.
Methods: In this pre‐post prospective design study, 13 participants with type 2 diabetes recruited from a primary care clinic in Boca Raton, FL were asked to complete a survey called the Diabetes Self‐Management Questionnaire (DSMQ), after which they attended a face‐to‐face or virtual PowerPoint presentation done in Haitian Creole with an optional 1‐hour discussion session. Following the class, they completed the same self‐management questionnaire with 2 additional investigator‐developed questions regarding class benefit.
Results: Paired sample t tests were performed to compare the pretest to posttest scores on the DSMQ questionnaire which showed statistically significant improvement.
Conclusion: The study found a perceived benefit in a self-management educational class in Haitian Creole for Haitian patients with type 2 diabetes.

Palliative Care services are underutilized in patients who have cancer primarily due to lack of understanding of what it encompasses by both, the patients and providers. The purpose of this quality improvement project was to facilitate Palliative Care referrals by the use of a Palliative Care screening tool: the Edmonton Symptom Assessment Scale with the Canadian problem Checklist and the PCQN Distress Screener. The Representational Approach and Jean Watson’s theory of Unitary Caring were utilized in the teaching moment. The screening tool was implemented at initiation and change of treatment during teaching visits by the nurse practitioners with the goal to increase palliative care referrals by 10% over a 3-month period of time and compared to the previous year. The results indicate that there were more palliative care referrals in the project implementation phase than the control quarter. A Chi Square test of Independence illustrated a statistically significant difference in the number of referrals during the project implementation phase versus the control quarter. The project’s short duration along with seasonal population fluctuations in South Florida limits data comparison to the previous year. A total of 10 palliative care referrals were made by nurse practitioners during the teaching visit in the 12-week project implementation period contributing to 3.5% of all palliative care referrals made. It is recommended that the project continue to provide more points for data analysis and continued patient exposure to palliative care services.

Heart disease remains the number one cause of death in America. The role of primary care in mitigating the prevalence of heart disease is to identify and reduce risk factors. One of the primary risk factors is atherosclerosis which can lead to coronary arterial disease if uncontrolled. A plant based/vegan diet is the safest and one of the most effective modalities for reducing the risk of or even reversing atherosclerosis and associated heart disease. This DNP project sought to assess the effectiveness of a 6-week plant-based diet intervention on cholesterol, perceived wellbeing, and perceived stress on patients diagnosed with hyperlipidemia. After the 6-week intervention period, there was an average 10.2% decrease in total cholesterol, 17.1% drop in LDL cholesterol, and an 8.7% increase in HDL cholesterol. Furthermore, 100% of participants recorded an increased sense of perceived wellbeing and there was an average 44% decrease in self-reported stress levels. The results of this study suggest that the plant-based diet intervention is an effective method for not only lowering cholesterol and the risk for heart disease but for also improving wellbeing and lowering stress. However, further investigation with a larger, more diverse sample is necessary.

Cardiovascular diseases are an important public health issue that effects all racial/ethnic groups.
A plant-based/vegan diet is safe and effective modality for reducing risk of atherosclerosis and heart disease.
This DNP project assess the effectiveness of a 6-week plant-based diet intervention on cholesterol, perceived wellbeing, and stress on patients diagnosed with hyperlipidemia.

Antibiotic misuse has been linked to increased health care costs, potential adverse reactions, and antibiotic resistance (Weddle, 2017). The purpose of this DNP project is to examine if implementation of an Antibiotic Stewardship checklist and algorithm at two After Hours Pediatrics (AHP) urgent care clinics, would affect provider knowledge and prescribing practices in the management of sinusitis. Antibiotic stewardship is the effort to measure antibiotic prescribing, improve antibiotic prescribing by clinicians, minimize diagnoses, and ensure the correct antibiotics are selected when needed (Sanchez et al., 2021). The overall goal is to minimize unnecessary antibiotic prescriptions for sinusitis to reduce the risks of antibiotic resistance and adverse reactions. To achieve this, a quality improvement (QI) project that included a diagnostic criteria checklist and management algorithm was tailored and implemented for healthcare providers at two AHP clinics.

Intimate partner violence (IPV) is a global health problem affecting millions of individuals. The purpose of this DNP project is to compare current IPV practices and recommend use of an IPV screening tool into practice along with staff education to improve screening practices in primary care. The overall goal is to increase screening of IPV in primary care, which rates are currently very low throughout the nation.
To achieve this goal a quality improvement project was conducted with participants at a local clinic in Fort Pierce. The staff and providers received a PowerPoint and verbal presentation, which focused on the ability to identify IPV. They received a pre-intervention survey and a post intervention survey at the completion of the presentation. They were also given information on referrals and resources for patients identified with IPV. 54% of providers responded that they do not currently screen for IPV. Participants showed that they would in the future use a screening tool in practice. They also showed a significant change in perceptions after the intervention. Providers also felt that they do have time to screen for IPV in the future and thus resulting in practice change.

Type II diabetes mellitus (T2DM) is a complex and multifactorial disease that can negatively affect a person’s physical and mental health. This disease is rapidly becoming one of the worst healthcare problems in America as rates are predicted to increase by 54%, impacting more than 54.9 million, by the year 2030 (Rowley, et al., 2017). Therefore, it is imperative that the health care system focuses attention on evidence-based measures that can improve diabetes control and prevent disease-related complications. Providing in-depth diabetes self-management education and support (DSME/S) to patients is necessary for them to successfully manage their chronic illness at home. The following Doctor of Nursing Practice quality improvement project aimed to improve diabetes outcomes in the community in collaboration with a local hospital organization, Holy Cross Health, located in Fort Lauderdale, Florida. This evidence-based change in practice project involved the implementation of additional in-person follow-up education and support following the completion of a diabetes program. The education and support provided was based on program content and current evidence in diabetes management and treatment. An in-depth synthesis of current evidence on DSMP and DSME/S was utilized for this project. This paper outlines the steps involved in measuring the impacts of continued support following completion of a program on diabetes control. A data analysis is described involving paired samples t-test and mean differences between baseline and post-intervention for health outcome measurements of weight, waist circumference, self-reported fasting blood glucose, self-reported serum hemoglobin A1C levels. In addition, a Diabetes Self-Management Questionnaire (DSMQ) and a Diabetes Distress Scale (DDS) were utilized comparison measurement tools.

A lack of knowledge and involvement in grassroots legislative advocacy among nursing professionals adversely affects nurses’ ability to effectively tackle issues impeding the safe and effective delivery of healthcare. The role of primary care nurses in improving health outcomes includes developing substantial legislative relationships that constructively introduce nurserelated issues that are not adequately recognized or understood by legislators. This DNP quality improvement project sought to assess the effectiveness of a four (4) week legislative advocacy training program on the knowledge of, confidence in, and participation in the legislative advocacy process and local legislative outreach among nurse members of the Florida Nurses Association. Following the four (4) week intervention period, self-reported knowledge and confidence improved significantly evidenced by a reported 77.8% increase in advocacy knowledge and an 81.5% increase in advocacy skills. More than 80% of participants documented confidence in their ability to participate in legislative outreach with a 44% increase in contacting a legislator by email or mail, a 7.4% increase in legislative outreach by telephone, and a 7.4% increase with in-person visits. The results of this study suggest that increasing advocacy training, by incorporating frequent, repetitive sessions over a short period of time, is an effective approach to improving legislative outreach among nurse professionals.