Hain, Debra

Chronic kidney disease (CKD) affects millions globally, often remaining undiagnosed until reaching advanced stages. Early detection, especially in high-risk populations such as those with diabetes, hypertension, or a family history of CKD, is critical for improving outcomes (National Kidney Foundation, 2020). Diabetes is the leading cause of CKD, followed by hypertension, and screening for microalbuminuria is an effective, low-cost method for early detection. This Doctor of Nursing Practice (DNP) project sought to improve healthcare providers' knowledge, attitude, and practices (KAP) regarding CKD screening and management by implementing newly released Kidney Disease: Improving Global Outcomes (KDIGO, 2024) clinical practice guidelines in the primary care setting. The project was conducted at the HANDS Clinic where eight providers who had direct patient care participated. It utilized educational tools, including an audio-video presentation, a mobile app, and infographic posters, to support protocol adoption and promote evidence-based screening. Providers completed pre- and post-intervention questionnaires during a six-week period to assess changes in KAP. Results showed significant improvements in providers' understanding of CKD risk factors and screening criteria and increased confidence in managing at-risk patients. These findings suggest that structured screening protocols, supported by educational resources, can positively impact provider-driven preventive care, leading to earlier CKD detection and improved patient outcomes. This project serves as a model for primary and community health clinics to enhance health promotion and disease prevention for individuals at risk of CKD (Bello et al., 2019). The project supported Healthy People 2030 goals by increasing diabetic kidney screening, raising awareness of CKD, and reducing disease burden. It also aligned with Triple Aim initiatives by improving care quality, reducing costs, and promoting better health outcomes in the diabetic population.

The worldwide threat of Diabetes Mellitus (DM) has been increasing rapidly, and is now an estimated 463 million, of which 55 million people originate from Middle East and Nort African (“MENA”) region (international Diabetes Federation [“IDF’], 2020). In Saudi Arabia, the prevalence of diabetes has roughly reached a ten-fold increase in the past three decades, placing Saudi Arabia’s incidence as one of the highest globally (Almubark et al., 2022). The purpose of the study was to examine the relationship between health and diabetes self-management among Saudi adults with Type 2 Diabetes Mellitus (T2DM). The study further aimed to explore how Saudi adult with T2DM seek and utilize diabetes knowledge to self-manage their diabetes. The study was guided by Leininger’s Culture Care Diversity and Universality Theory (2002). Leininger’s Sunrise Enabler- Model provided a framework to explore the various factors that affect diabetes self-management through a cultural lens. This model provides a comprehensive understanding pf multiple factors influencing diabetes self-management.
A sample of 66 Saudi adults with T2DM aged 40-61 and older was recruited from diabetes center and Primary Healthcare Center (PHCC) at National Guard Hospital King Abdulaziz Medical City Jeddah, Saudi Arabia. A Parallel Mixed Method (PPM) design was applied, using semi-structured interviews, Diabetes Self-management Questionnaire (DSMQ), Short Test of Functional Health Literacy in Adult (S-TOFHLA), and sociodemographic surveys.

Background: Alcohol use disorder (AUD) is a serious problem that has affected countless of people in the United States. This disorder is difficult to treat and despite evidence-based treatments, there continues to be a problem. Treatment centers often attempt to address AUD with personalized detox protocol based on tradition and evidence that attempt to target pertinent factors that may increase the likelihood of sustained abstinence. Purpose: To conduct a program evaluation of thedetox protocol for patients diagnosed with AUD at a treatment center in south Florida. This program evaluation will yield important information regarding the outcomes of an established program. This project identified strengths, opportunities for improvement, and opportunities to support current practice at this facility.

Deficits in patient and provider knowledge in the use of complementary and integrative care (CIC) methodologies resulted in the planned creation of a future CIC educational course for outpatient advanced practice registered nurse practitioners (APRNs) who often serve as a primary source of health education for their patients. A survey, which was based upon the Theory of Bureaucratic Caring and the Canadian Institutes of Health Research’s (CIHR) knowledge-to-action (KTA) cycle, and incorporated elements of the Complementary and Integrative Health Assessment for Practitioners (CIAHP) and the Complementary and Alternative Medicine Beliefs Inventory (CAMBI), was created to assess the CIC educational needs of APRNs employed in primary care/outpatient settings. Survey participants identified their preferred method of instruction, top areas of CIC topics of interest and occupational applicability, and preferences for CIC educational course design and delivery. A low ratio of survey respondents versus completion rate and the lack of participant occupational and demographical diversity were observed challenges. Survey data supported the need for the creation and implementation of a pending CIC educational course with a goal of mirroring the educational needs of advanced practice registered nurses.

Obstructive sleep apnea affects an estimated 936 million people worldwide (Pivetta, 2021). Untreated OSA can lead to adverse metabolic, cardiovascular, and neurocognitive consequences, possibly reducing one’s lifespan. Education and screening can spread awareness among a community which typically has limited access to resources and may promote early recognition and treatment.
In a Christian-based prison reentry residential community, a pre-test survey was provided to a total sample of 19 participants to measure baseline knowledge of OSA. After administration of the pre-survey, education was provided in a group setting, using a detailed brochure the DNP student created. After participants read through the material and questions were answered, the post-survey was administered to measure if knowledge regarding OSA increased. Screening using the STOP-Bang questionnaire occurred after the post-surveys. The DNP student followed up with participants found to be at high risk for OSA patients over a 3-month period. A 37% of participants scored high risk for OSA, 37% scored intermediate risk, and 26% scored low risk. The p-value calculated to measure pre-and-post OSA knowledge using the survey total score was statistically significant (< .001.). Of the seven total participants who scored high risk, two were newly diagnosed with OSA after referral to a PCP for a sleep study with the help of the telephonic phone sessions. Education and screening demonstrated to be beneficial, resulting in positive outcomes. Project partakers were successfully able to define OSA, list risk factors, and describe how to diagnose and treat the condition. Participants who were newly diagnosed, previously diagnosed, or refused the sleep study managed to adjust modifiable risk factors over the summer such as weight loss, diet, and management of chronic conditions.

Type 2 diabetes is a public health challenge. Researchers at the center of disease control and prevention (CDC), report more than 34 million Americans have diabetes (about 1 in 10) (CDC, 2019). Uncontrolled diabetes over a long period of time can result in end-organ damage. End results of poor glycemic control can result in diabetic retinopathy, neuropathy, kidney disease and kidney failure (Sacks, 2017). In type 2 diabetes (T2D) cells do not respond normally to insulin, a condition known as insulin resistance. These results set the stage for pre-diabetes and type 2 diabetes. Type 2 diabetes often develops in people over age 45, but more recently children, teens, and young adults are also developing type 2 diabetes. Type 2 diabetes in children are rising due to obesity rising. According to the CDC, more than 75 % children with type 2 diabetes have family members who also have it (CDC, 2019). With this being said, many evidence based research studies reveal how diabetes self- management is influenced by one’s confidence and willingness to manage diabetes. The patients desire to enhance their knowledge, skills and confidence is referred as “Patient Activation.” Increasing patient activation will help people manage their diabetes more effectively and be active in self-management behaviors (Regeer, Van Empelen, & Bilo, 2021).

Cardiovascular disease is a serious health condition that affects the blood flow to and from the heart. It is currently one of the leading causes of death globally as it accounts for approximately 32% of deaths each year (WHO, 2021). In Palm Beach County, cardiovascular disease is the leading cause of death accounting for 23.7% of overall deaths (Palm Beach County, 2022). The risk for developing this disease increases when other comorbidities exist such as diabetes, hypertension, hyperlipidemia, or an elevated Body Mass Index (BMI). With proper knowledge and lifestyle modifications, risks from complications are lowered. It is for this reason that a QI project was implemented, to see if a community prevention program (CPP) could help improve knowledge and behavior changes within a population. Overall, six participants completed the program, three males, and three females. Results showed that 83% of participants lowered their HgA1c while there was a 100% increase in blood pressure. Results also showed a decrease in BMI for 33% of participants, and an increase in BMI for 17% of participants. Overall cholesterol decreased by 66%. Based on the self-efficacy survey that participants took, it appeared that they were more confident and likely to identify healthy food choices and increase their aerobic exercise and activities. Although initial goals were not fully met, the implications of this project showed that a CPP can improve certain biomarkers that could help reduce the risk of cardiovascular disease. A longer period of time and larger sample size might yield much different results. It would also be beneficial to trend certain biomarkers such as BMI and blood pressure multiple times throughout the duration of the program to determine if a change occurs over a longer period.

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.

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.