Hain, Debra

Cardiovascular disease continues to be a medical concern affecting millions globally. 17.9 million people die each year from cardiovascular disease (CVD), representing 32% of all deaths worldwide, (World Health Organization, 2021). Despite medical evidence and continuous awareness efforts in treating CVD, people continue to engage in behaviors and lifestyles that ultimately increase their risk of developing CVD. In effort to help curtail the incline of heart disease, the aim of this quality improvement project was to increase CVD awareness, knowledge of personal atherosclerosis cardiovascular disease (ASCVD) risk profile and encourage behavior modifications that lead to overall risk reduction. This was achieved by individualized educational sessions on cardiovascular health, discussion of lifestyle modification that reduces risk of developing ASCVD and undergoing CT CAC scores. Pre-test scores of CVD knowledge tool improved from a mean score of 40.66 to post-test mean score of 100, demonstrating that 100% of all participants showed increased knowledge of CVD, based on an alpha level of .05, [F(1, 48) = 55.02, p < .001]. In addition, risk modifying behaviors such as dietary choice improved after undergoing CAC scores and attending educational sessions. The mean of Unhealthy/Processed Food-Pre-Test was 3, denoting consumption of beverages with added sugars, fried and/or processed foods, at least 1-2 times per week, whereas post interventions mean score was 1.17, corresponding to consumption of unhealthy foods once per month or less, based on an alpha level of .05, [V = 168.00, z = -3.66, p < .001]. Lastly, the project demonstrated that understanding cardiovascular disease and associated ASCVD risk obtained by CT CAC scores led to increase in exercise and medication adherence.

There is an increase in residents with dementia receiving care in Skilled Nursing Facilities (SNFs). As the person's dementia progresses there is an increased risk of behavioral and psychological symptoms of dementia (BPSD) which include aggressive behaviors, screaming, and yelling. Frequently, psychotropic medications are used to treat behaviors, but it is associated with several risks, including risks of falling, high hospitalization rate, adverse events, and even deaths of the nursing home residents. The Centers for Medicare and Medicaid Services (CMS) are monitoring use and providers caring for individuals in SNFs will have to justify reasons for prescribing psychotropic medication (CMS, 2020). There is evidence of many interventions to treat BPSD. There is a need to translate this evidence into practice to see if we can reduce the use of psychotropic medications.

The incidence of acute kidney injury AKI (also known as acute renal failure) is an emerging public health concern worldwide and it is associated with high healthcare cost, prolonged hospital stays, progression to chronic kidney disease and end-stage renal disease and higher mortality. Advanced age increases the vulnerability to AKI due to both structural and functional degeneration over time affecting many older adults living in long term care facilities. The literature shows AKI is preventable with early detection and management. The purpose of this quality improvement project was to assess if the implementation an evidence-based education presentation to a group of nurses in a long-term care facility on early detection and management of AKI while improving the staff’s knowledge, confidence and competence will prevent the AKI in the facility, decrease AKI related hospitalizations and ultimately improve health outcomes. The plan, do, study, act (PDSA) method was used, and descriptive statistics were utilized to analyze the data of this project obtained from a pre-post survey questionnaire. A retrospective chart review of hospitalization data was utilized to record pre and post intervention hospital discharges. Results indicated that the education presentation improved knowledge and management of AKI; therefore, recommendations for practice change are necessary.

Hypertension is a national health concern that can increase the risk for cardiovascular disease. Healthy People 2020 recommends improving cardiovascular health by increasing the number of adults who check their blood pressure and understand whether it is high or low. In an effort to improve outcomes in adults with hypertension, this quality improvement project was implemented at a primary care setting aimed at improving blood pressure control through self-care behaviors. The intervention included providing staff education on the HBPM program called IHEALTH, an educational counseling session for recruited participants (adults ages 21- 85 with a diagnosis of HTN within the last year or uncontrolled HTN) in which a pre-test blood pressure knowledge and self-care scale on hypertension were administered. There were statistically significant improvements in BP from pretest to posttest on the average the Mean Arterial Pleasure (MAP) and Systolic BP. The MAP decrease from an average of 105.7 to 100.4 [t(7)=2.32, p=.027, Cohen’s D=1.76] whereas the SBP decrease from an average of 142.9 to 128.4 [t(7)=2.74, p=.015, Cohen’s D=2.07]. There was a small but nonsignificant decrease in DBP from an average of 87.1 to 86.4 [t(7)=0.17, p=.868, Cohen’s D=0.129]. The preintervention knowledge scale rose from a mean score of 69 to a mean score of 88 on the post test. The post intervention pre-intervention self-care score rose from an average of 44 to a post intervention average score of 75. The project showed that the implementation of a quality improvement project in a primary care setting with staff involvement can lead to participant blood pressure control through promotion of participants self-care behaviors. Therefore, implications for practice include incorporating HBPM programs into practice due to the high potential for improving blood pressure control through self-care behaviors. In addition, the implementation of a HBPM program in addition to office blood pressure is important for diagnosis and monitoring HTN (Kairo et. al., 2019).

The purpose of this pilot study was to determine the effect of vignettes about Alzheimer’s dementia (AD) on stigma and attitudes toward people with Alzheimer’s dementia (PWAD) in a sample of community residents of adults 65 years and older. The specific aims of this study were: (1) to determine the effect of vignettes on AD- related stigma and negative attitudes toward people with AD among adults age 65 years and over, and (2) to describe AD- related stigma and negative attitudes in ethnically and racially diverse groups of older adults. A convenience sampling design was used to recruit 50 participants from a medical office in Boca Raton. The sample included adults age 65 years and older from the community, who understood English and scored 25 or higher on Mini Mental State Exam (MMSE). Participants were randomly assigned to the control group (n=22) who received standard AD education or to the intervention (n=28) who received vignettes and standard AD education. Independent t-test was used to analyze the pretest- posttest change scores in the measures of DAS and STIG-MA survey. The significance (p value) was set at .05. In research question two, the samples were
divided into 1) white non- Hispanic and 2) other diverse groups. Descriptive statistics were used to explore racial or ethnic differences in stigma and attitudes. The intervention used vignettes and AD education to decrease stigma and attitudes toward people with dementia and showed statistical significance as compared to the control group who received only the AD education.

In 2014 Bodenheimer and Sinsky published the Quadruple Aim model, which argued that healthcare provider wellbeing was the missing link to improving patient and population health outcomes, as well as cost containment. Rather than treating burnout, however, experts in fields outside healthcare are finding validity in promoting thriving at work as a means to prevent burnout and improve employee satisfaction, engagement, and productivity. The purposes of this study were to investigate the relationship between thriving and emotional exhaustion (which is widely considered a core element of burnout) in healthcare providers, and the impact thriving had on primary care population health outcomes as measured by quantifiable value-based quality performance metrics. Using Georges' (2013) Emancipatory Theory of Compassion and Bodenheimer and Sinsky's Quadruple Aim as conceptual frameworks, this descriptive, non-experimental study used advanced applied biostatistical techniques to analyze archival data from the December 2018 UCHealth Physician and Advanced Practice Provider Voice Survey as well as provider performance scores from the same time period. Results of the study were mixed, showing that while there is an inverse relationship between thriving and emotional exhaustion in healthcare providers, thriving did not predict population health outcomes. By evaluating thriving in healthcare providers in relation to emotional exhaustion and in context of value-based health care delivery systems, this study was the first of its kind.

Despite aggressive efforts to help people achieve target blood pressure goals, currently in the US, only 52% of patients with hypertension have achieved blood pressure goals as established by JNC 8 (Low et al., 2014). Hypertension correlates with a greater risk of myocardial infraction, heart failure, stroke, and kidney disease (Low et al., 2014). Early detection and intervention is essential to reduce mortality and morbidity (Beune et al., 2014). Target BP is a national initiative formed by the American Heart Association (AHA) and the American Medical Association (AMA) in response to the rising incidence of uncontrolled blood pressure (BP). The program established protocols including teaching patients how to measure blood pressure accurately as well as partnering with families, patients, and communities to promote self-management goals in hypertension. The Target BP program was implemented by the staff at one primary care practice in South Florida to improve blood pressure in their patient population. This health center serves hundreds of thousands of patients in the South Florida area to meet the needs of primary care in the community. The intention of this doctoral project was conduct a program evaluation of Target BP within this community health center in order to understand if the program should be adopted, adapted, or abandoned. All 114 patients enrolled in the Target BP program at the community health center where evaluated for improvement in hypertension during a four-month period. Twenty-five patients had blood pressures collected for all four months. The community health center exceeded their goal of 10% decrease in in the patients with uncontrolled hypertension within the organization. In total, 47 (41%) patients showed improvement in blood pressure to normal limits according to JNC8 standards over the 4 months. Program interventions were implemented per protocol when patient’s blood pressures were out of range. Staff nurses and healthcare providers provided interventions to address diet, exercise, monitoring blood pressure on logs, as well as taking medication for hypertension to encourage achievement of Target BP goals.

The purpose of this exploratory-descriptive study was to compare the different living arrangements of older Thai adults on healthy aging and well-being in those attending the elderly school. The specific aims of this study were (1) to describe demographic characteristics, and (2) to identify differences between the outcomes the Thai Healthy Aging Instrument (HAI) and the Personal Wellbeing Index (PWI) in older Thai adults 60 years and older based on the types of living arrangements. The Convoy Model of Social Relations was used as a guide for understanding the multifactorial nature of the social connection (Kahn & Antonucci, 1980). A convenience sampling design was used to recruit 139 participants living in Tambon Hua Ngom, Chiang Rai province, Thailand, for at least a year.
The sample included adults age 60 years and older who read and spoke Thais and had been participated in the elderly school at least once a month for one year. Among the participants (N = 139), 30 lived alone, and 109 lived with others. The findings of this study indicated that there were no statistically significant relationships between demographic characteristics between those who lived alone and those living with others, except for marital status. The participants living alone were more likely to be widowers compared to those living with others (p < .05).