Chadwell, Katherine

In the aftermath of the Covid-19 pandemic, bereavement and grief have become two widely used terms in modern day society. The terms are often used interchangeably to describe a feeling of deep sorrow felt after the loss of a loved one. Often it can be difficult for individuals to cope with the loss of a loved one, and it is estimated that 20% of bereaved individuals will experience complicated grief (NAMI, 2021). Complicated grief, often referred to as a prolonged grief disorder, can be defined in several ways. Today, the most widely accepted definition of complicated grief is grief that persists for longer than one year and significantly interrupts an individuals’ ability to complete daily functions (Cleveland Clinic, 2022).
Each year, there are roughly 2.6 million deaths in the US alone, leaving behind approximately 13 million individuals (about twice the population of Arizona) to grieve (U.S. Census, 2021). A study conducted in 2019, surveyed 1,084 US adults and found that 32% had experienced grief following the death of a loved one in the past three years (The Grief Experience, 2019). Furthermore, of U.S. adults over the age of 65, 71% reported experiencing bereavement in the previous 30 months (Williams & Sawyer, 2017).

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
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.

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.

The incidence of uncontrolled diabetes among the adult population of the United States, especially individuals over 65 years, remains a critical issue and is on the rise. Florida is one of the most affected states with the largest population of adults ages 65 and older in the nation (FDAC, 2017). Adults within minority groups face the greatest hardships as they often do not have access to proper diabetes educational programs resulting in a higher prevalence of diabetes with a higher risk for developing diabetes-related complications (Ricci-Cabello et al., 2014). Diabetes is a chronic disease that requires a person to make a multitude of daily self-management decisions and perform complex care activities. Diabetes programs providing self-management education may be one of the solutions to addressing this problem, both nationally and locally. This project evaluated the effectiveness of the diabetes education program at the Cora E. Braynon Family Health Center, a community health clinic caring for underserved individuals. A total of 15 patients were followed throughout their participation in the program in June and July of 2019 for three months. Measurable outcomes for this program evaluation included participation in the program as evidenced by chart review, glycemic control by means of hemoglobin A1c measurements, self-management behaviors including diet, activity and exercise, and medication adherence by administering the Diabetes Self-Management Questionnaire (DSMQ) both pre- and post-participation in the program. Patient satisfaction with the program was measured using qualitative interview techniques. The interprofessional team members’ perception of the program was measured using a questionnaire based on the 10 ADA Diabetes Self-Management Education Standards as well as by qualitative interview. Alignment with the 2017 National Standards for Diabetes Self-Management Education and Support Curriculum Core Content Areas was measured by direct observation. After three months, 28% of the patients referred by their primary care provider attended both sessions in June, while 37% of patients referred attended the first session in July and 40.7% the second, meeting the set goal. After three months the following objectives were met: at least 15% of participants reported improvement in diet, activity and exercise, and medication adherence as compared to baseline scores on the DSMQ, 100% of patients and members of the interprofessional team reported satisfaction with the program, and 100% of the interprofessional team reported knowledge of the 2017 National Standards for Diabetes Self-Management Education. After three months, the following measured objectives were not met: only one participant reached the set goal of a 1% reduction in their recorded hemoglobin A1c levels, and during direct observation of program processes, only five of the eight standards from the 2017 National Standards for Diabetes Self-Management Education and Support Curriculum Core Content Areas were met. Core content areas of activity, healthy coping with psychosocial issues and problem solving, needed improvement. Such results support the push for the addition of a mental health counselor to the Care Coordination Team.