Bulfin, Susan

Cervical cancer screening and prevention is an important aspect of primary care. Primary care providers (PCPs) have the role of either performing the initial screening test or referring to gynecologists for testing and follow-up care if needed. The PCPs have the opportunity to to discuss the importance of cervical cancer screening at each encounter. This is of particular importance for African-American (AA) women. According to Gopalini et al. (2020) AA women have significantly higher cervical cancer incidence and mortality rates than Non-Hispanic Whites. This quality improvement project was conducted to increase the understanding of cervical cancer screening and uptake among African American Women in a south Florida medical center. Educational sessions were implemented based on Cervical Cancer Screening (CCS) guidelines from the American College of Obstetricians and Gynecologists (ACOG), instructional materials from the Centers for Disease Control and Prevention (CDC), and best practices in recommending CCS to the participants by the project team leaders (PTLs). The project processes were guided by Dr. Elizabeth Barrett’s Theory of Power as Knowing Participation in Change (PKPC) and underpinned by Dr. Jean Watson’s theory of human caring. Twenty-five patients participated and followed through the end of the project. Every participant received educational sessions and materials, expressed an intent to complete pap test, and completed pap screenings. The tool CCS-KAP Survey (Cervical Cancer Screening Knowledge, Awareness, and Practices) was used to evaluate participants’ cervical cancer screening knowledge and practices in both pre- and post-intervention periods. The results demonstrated enhanced knowledge and increased uptake for pap screenings among this group.

Purpose: This project was implemented to address and improve the need for management adherence among the Afro-Caribbean pediatric population with Type 1 and Type 2 Diabetes (T1D) and (T2D).
Background and Problem: Over the past 5 years, there has been an increased number of children diagnosed with diabetes. Particularly, one of the problems being faced by Haitians and other Afro-Caribbean patients with chronic illnesses, is poor management adherence due to lack of culturally congruent education. Additionally, the lack of education seen in patients with diabetes is correlated with difficulties to adapt and manage the condition properly.
Method: Each participant received education that was tailored to the Afro-Caribbean culture and in their preferred language. Summary of diabetes self-care Activities (SDSCA) score and time in range values were assessed pre intervention and post intervention. A paired sample t-test was conducted by this Doctor of Nursing Practice student to assess the changes from pretest to posttest. A p-value of less than 0.05 was required for statistical significance.
Results: More than 75% of the participants were educated with culturally congruent teachings that were tailored to the Afro-Caribbean culture. Improvement in SDSCA scores and TIR was also demonstrated. SDSCA p<.001 and TIR p=0.008. In addition, more than 75% of the participants demonstrated improved adherence to blood glucose monitoring consistency which was statically significant.
Conclusion: The effectiveness of this project was evaluated by the outcomes of the participants’ post intervention. Findings from this project demonstrated that providing culturally congruent education to patients was successful at improving diabetes home management.

Human papillomavirus (HPV is the most common sexually transmitted infection(STI) in the United States, with an estimated 80% of sexually active people contracting it at some point. HPV can cause cervical, vaginal, and vulvar cancers in females, as well as anal cancer and genital warts in males. However national data demonstrates less than 50% of females are fully vaccinated. This quality improvement project aimed to bridge the gap in young women who did not receive the vaccine during childhood as well as increase knowledge about HPV, transmission, vaccination, and testing. The interventions used to facilitate the education included an HPV pamphlet and direct education with the trusted provider using motivational interviewing techniques. Pre and post tests were given to 48 participants that assessed HPV knowledge and intent to vaccinate. Participants included females < 27 years old with thirty-six participants who fully completed all aspects of the QI project at an OBGYN private practice. The intent to vaccinate in the pretest was 8% and posttest was 67%, with a percent increase of 700%. The pretest HPV knowledge average test score was 72% with an average post test score of 91%. The results of the project add to the body of evidence-based practice knowledge and clearly demonstrate the effectiveness of education with a strong provider recommendation in increasing vaccination uptake. The methods and modalities used for this project could easily be implemented in any practice following this particular patient population such as university student health systems or family practices.

The purpose of this paper is to illustrate a Doctor of Nursing Practice Project through the implementation of a structured quality improvement project, designed to increase the use of evidence-based practice (EBP) among psychiatric nurses in a metropolitan acute care setting. An increase in understanding and use of EBP was achieved by comparing data obtained from pre-implementation and post-implementation surveys designed to seek attitudes toward, knowledge of, and use of EBP in a psychiatric setting. This evidence-based proposal is aligned with the Christine E. Lynn College of Nursing’s caring philosophy and the call for using evidence-based information to inform nursing practice.

The goal of this quality improvement project was to increase medication adherence in patients post allogeneic hematopoietic stem cell transplant (allo-HSCT) following hospital discharge. The aim was to evaluate the impact of implementing an individualized post-transplant education intervention, grounded in Roach’s human caring attributes, on medication regimen adherence post-transplant (allo-HSCT) following hospital discharge. The intervention included use of a pill box and medication calendar (PPM). Patient-Nurse interactions were guided by conscience and occurred within an environment of trust, respect, and compassion in which the nurse connected in full presence to the patient’s situation and demonstrated skills and knowledge (competence). A prospective, single arm, instructional intervention design was used to compare medication regimen adherence pre- and post- intervention. The effectiveness of the educational approach was evaluated using the Morisky Medication Adherence Scale-8 (MMAS-8). Participants included all patients who underwent allogeneic stem cell transplantation and discharged from the project facility between June 15th, 2021 and September 15th, 2021 (n=10). Prior to the PPM intervention, 20% of patients fell into the high medication adherence category, 40% were in medium adherence, and 40% in low medication adherence category. Four to five weeks after the PPM intervention, 70% were found to be in high adherence category and 30% in the medium adherence category. A paired sample t-test conducted on mean MMAS-8 score Pre- and Post- PPM intervention was found to be statistically significant (Mean 6.725 Versus 7.675, p=0.034). Early implementation of the PPM intervention involving individualized post-transplant instruction, grounded in caring science, was beneficial for post-transplant medication adherence in allo-HSCT patients following hospital discharge. Future research studies are needed to confirm the effectiveness and generalization of the PPM intervention.

This paper described a quality improvement project with a goal of decreasing depression symptoms through the use of specified community mental health resources. The aim of this project was to decrease depression scores for pediatric patients by offering information on available community resources. This was achieved by providing an evidence-based pamphlet with community-based mental health resources to patients who scored high on the depression screening. This intervention addressed an identified gap at the site concerning mental health services for depressed adolescents. Objectives included providing patients who screen positive for depression the community resource list, obtaining decreased scores on the Patient Health Questionnaire-9 (PHQ-9) depression screening 6 weeks post intervention, and return visits for follow up appointments for re-assessment. All adolescents ages 12-18 who visited the pediatrician’s office from June 2, 2021, to July 7, 2021, for an annual well visit or mental health complaint were offered the PHQ-9 screening. Patients who scored 5 or higher were invited to participate in the project for a total of 20 participants. The 3 objectives for this project were not met. Providers demonstrated low participation and adequate follow-up was not provided resulting in lack of the PHQ-9 rescreening. Recommendations for future efforts to increase to decrease depression symptoms would be to determine barriers to providers recommending community resources and incorporating modifications to the project based on provider identified barriers. A longer period (such as 6 months) could also assist in increasing provider participation and patients’ use of community resources.

Due to increasing numbers of family nurse practitioner programs and lack of
suitable pediatric clinical sites, other alternative methods such as using simulations must be
sought out in order to increase confidence levels and enhance family nurse practitioner (FNP)
students' preparedness to practice with the pediatric population.

This Doctor of Nursing Practice (DNP) project describes a quality improvement (QI)
project to address the problem of male breast cancer (MBC) in a medically underserved
population in the southeastern United States. The purpose of this project was to implement a
practice protocol to increase breast cancer screening rates to potentially improve early
identification and management of men at risk for breast cancer in an outpatient safety net clinic.
The Six Sigma DMAIC methodology guided the development, implementation, and evaluation
of the project. A pre and post intervention survey was utilized to measure nurse practitioners’
knowledge, attitude, and practice (KAP) about MBC screening and a chart audit tool was utilized
to measure adherence to the protocol. The results revealed statistical significance. The nurse
practitioners demonstrated improved KAP of male breast cancer screening recommendations
based on responses to the pre and post questionnaires. The implementation of the male breast
cancer screening protocol led to a significant increase in the nurse practitioner’s MBC screening
rates. The findings reinforce continued education of nurse practitioners for male breast cancer
prevention. Public education is also pertinent for early detection and prevention of male breast
cancer worldwide.