Hershorin, Tracian Kelly

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.

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.

Heart failure is a chronic disease affecting millions of people worldwide and carries a high burden on both patients and society. Current guidelines encourage the use of patient education along with medical therapy to improve outcomes. The aim of this manuscript is to describe a quality improvement (QI) project conducted to improve self-care behaviors among participants living with heart failure. The need for this project was identified at an outpatient clinic where patients with heart failure (HF) were not receiving printed education materials or enhanced instruction. Through literature review, several studies identified potential barriers to adherence including complexity of treatment, low health literacy, and heart failure symptoms, while other studies displayed the positive impact of enhanced instruction on heart failure outcomes and self-care. This QI project was conducted over a 4-week period and involved a telehealth intervention utilizing printed education and teach-back to improve self-care behaviors. Participants completed self-care behavior surveys pre and post intervention. Improvements were noted among self-care scores of all the participants, although the sample size was small. From these results, it was recommended to the outpatient clinic to continue to provide printed education to patients with heart failure and incorporate a telehealth follow-up program to emphasize proper self-care behaviors for these patients. Future projects and research should be focused on larger sample sizes for longer periods of time and include the tracking of heart failure outcomes.